Katherine Tuttle, MD: Many Options Available in Nephrology

In recent years several new drugs and treatments have come on the market to treat a variety of kidney diseases.

One of those drugs presented at the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., is dulaglutide. In a new study, investigators found that dulaglutide resulted in at least a 40% estimated glomerular filtration rate (eGFR) decline and a 50% risk reduction in end-stage kidney disease.

Katherine Tuttle, MD, professor of Medicine, University of Washington, explained in an interview with MD Magazine® some of the benefits of dulaglutide and how the nephrology space has improved in recent years.

MD Magazine: On the impetus behind the dulaglutide study?

Tuttle: Well the impetus for doing the dulaglutide dual study, also known as AWARD-7, was the large unmet need for new agents to treat diabetes in patients with advanced stages of CKD.

So, we use dulaglutide in patients with CKD stages 3 and 4 to lower blood glucose in direct comparison to insulin, which has been the standard of care.

What we showed is that not only was it as effective at insulin and lowering blood glucose, but we had a much lower rate of side effects. A 50% reduction in hypoglycemia for example.

But the main secondary outcomes were related to kidney disease. Dulaglutide produced a remarkable reduction in albumin area but also significantly controlled GFR decline.

So that people who got dulaglutide lost no kidney function over 1 year, whereas the patients who got insulin lost the expected amount of kidney function.

So, if this would be continued over time this could have a major impact not only on better treatment for diabetes but also reducing progression to end-stage kidney disease.

MD Magazine: How will this study improve patient outcomes?

Tuttle: Well first off, we have a new option or another option that we can use to treat hyperglycemia besides insulin. It's more convenient, just as effective, and causes fewer side effects especially hypoglycemia.

It really is emerging as part of the armamentarium to protect the kidneys. With regard to kidney protective therapies we've previously had really nothing that works at late stages of chronic kidney disease.

So, to have a drug that even at CKD stage 4 reduces progression is really a remarkable advance.

MD Magazine: What’s being overlooked in nephrology?

Tuttle: Well, I think we need to do more clinical trials. We need to move to an on-trial culture where we're continually testing new therapies that we hope will be safer and more efficacious.

We also need to be more precise about how we apply these therapies because we're now at a very exciting time where a number of therapies are emerging. But we need to do a better job of understanding how to phenotype patients so that we give the right treatment to the right patient at the right time.

Meaning there's some treatments that may work with some types of kidney disease and not others and some that may work at different stages and not others.

We've never been at this place where we have so many choices so it's an exciting time, but we really have to step up to the plate now and maximize the opportunity by again more precision phenotyping and applying the drugs in a more targeted way.