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논문분류	춘계학술대회 초록집
제목	Pharmacotherapy of Endothelin Receptor Antagonists for patients with Chronic Kidney Disease: A Component Network Meta-analysis and Systemic Review
저자	Qinbo Yang
출판정보	2024; 2024(1):
키워드
초록	Objectives: Endothelin receptor antagonists (ERA) along with dual endothelin and angiotensin receptor antagonist — sparsentan, are emerging medications. We performed a systematic review and component network meta-analysis (CNMA) to assess effects of newer drugs compared with current renoprotective medicines. Methods: Eligible RCTs compared drugs of interest with RASi in CKD patients. Eligible trials had a follow-up of 52 weeks or longer. Certainty was assessed following the GRADE approach. The CNMA is a variant of the standard NMA that allows dissection of complex interventions and estimation of the interactive effects of each component within them. It is worth noting that we reported the effect estimates with 90% confidence interval (CI), as non-inferiority margin, on the outcomes of eGFR slope and ESRD. Results: The analysis identified 10 eligible trials with 18368 patients, together evaluating four different drug classes. The interactive model of CNMA probed a significant interaction between SGLT2i and ERA that potentially compromise the sum efficiency of two drugs on reducing UACR at 3 month (Table.1). Although, the combination of SGLT2 inhibitors, ERA and RASi is identified as the most effective and followed by the other useful medications such as ERA+RAS, sparsentan and SGLT2i+RAS (Figure.2). ERA+RAS shows non-inferiority to RASi on eGFR slope and Sparsentan probably does (Figure.3). However, patients with ERA+RASi have a higher risk of hospitalization for heart failure compared to their counterparts with SGLT2i+RASi (Figure.4). The evidence is not robust, but there is a suggestion that Sparsentan may lead to an increase in adverse events compared to ARNI which provides significant benefits in reducing the risk of heart failure (Figure.5). Conclusions: UACR showed a favorable outcome with Sparsentan and addition of ERA, and non-inferiority to RASi was seen with them on eGFR slope. However, adverse effects, especially heart failure events, and drug-to-drug interaction should be taken seriously.
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