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Martin-Higueras C, Borghese L, Torres A, Fraga-Bilbao F, Santana-Estupiñán R, Stefanidis CJ, Tory K, Walli A, Gondra L, Kempf C, Gessner M, Habbig S, Eifler L, Schmitt CP, Rüdel B, Bartram MP, Beck BB, Hoppe B. Multicenter Long-Term Real World Data on Treatment With Lumasiran in Patients With Primary Hyperoxaluria Type 1. Kidney Int Rep 2024; 9:114-133. [PMID: 38312792 PMCID: PMC10831356 DOI: 10.1016/j.ekir.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The RNA interference (RNAi) medication lumasiran reduces hepatic oxalate production in primary hyperoxaluria type 1 (PH1). Data outside clinical trials are scarce. Methods We report on retrospectively and observationally obtained data in 33 patients with PH1 (20 with preserved kidney function, 13 on dialysis) treated with lumasiran for a median of 18 months. Results Among those with preserved kidney function, mean urine oxalate (Uox) decreased from 1.88 (baseline) to 0.73 mmol/1.73 m2 per 24h after 3 months, to 0.72 at 12 months, and to 0.65 at 18 months, but differed according to vitamin B6 (VB6) medication. The highest response was at month 4 (0.55, -70.8%). Plasma oxalate (Pox) remained stable over time. Glomerular filtration rate increased significantly by 10.5% at month 18. Nephrolithiasis continued active in 6 patients, nephrocalcinosis ameliorated or progressed in 1 patient each. At last follow-up, Uox remained above 1.5 upper limit of normal (>0.75 mmol/1.73 m2 per 24h) in 6 patients. Urinary glycolate (Uglyc) and plasma glycolate (Pglyc) significantly increased in all, urine citrate decreased, and alkali medication needed adaptation. Among those on dialysis, mean Pox and Pglyc significantly decreased and increased, respectively after monthly dosing (Pox: 78-37.2, Pglyc: 216.4-337.4 μmol/l). At quarterly dosing, neither Pox nor Pglyc were significantly different from baseline levels. An acid state was buffered by an increased dialysis regimen. Systemic oxalosis remained unchanged. Conclusion Lumasiran treatment is safe and efficient. Dosage (interval) adjustment necessities need clarification. In dialysis, lack of Pox reduction may relate to dissolving systemic oxalate deposits. Pglyc increment may be a considerable acid load requiring careful consideration, which definitively needs further investigation.
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Affiliation(s)
- Cristina Martin-Higueras
- German Hyperoxaluria Center, c/o Kindernierenzentrum Bonn, Germany
- Institute of Biomedical Technology, University of La Laguna, Tenerife, Spain
| | | | - Armando Torres
- Institute of Biomedical Technology, University of La Laguna, Tenerife, Spain
- Department of Nephrology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Fátima Fraga-Bilbao
- Department of Pediatrics, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Santana-Estupiñán
- Department of Nephrology, Hospital Universitario de Gran Canaria Doctor Negrín, Gran Canaria, Spain
| | | | - Kálmán Tory
- Pediatric Center, MTA Center of Excellence, Semmelweis University; Budapest, Hungary & MTA-SE Lendulet Nephrogenetic Laboratory, Hungarian Academy of Sciences, Budapest, Hungary
| | - Adam Walli
- Wisplinghoff Laboratory, Cologne, Germany
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, UPV/EHU, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Caroline Kempf
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Disorders, Charité Universitätsmedizin Berlin, Germany
| | | | - Sandra Habbig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Lisa Eifler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Claus P. Schmitt
- Division of Pediatric Nephrology, University Hospital Heidelberg, Germany
| | | | - Malte P. Bartram
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Bodo B. Beck
- Institute of Human Genetics, University Hospital Cologne, Germany
| | - Bernd Hoppe
- German Hyperoxaluria Center, c/o Kindernierenzentrum Bonn, Germany
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Pérez-Sáez MJ, Blasco M, Redondo-Pachón D, Ventura-Aguiar P, Bada-Bosch T, Pérez-Flores I, Melilli E, Sánchez-Cámara LA, López-Oliva MO, Canal C, Shabaka A, Garra-Moncau N, Martín-Moreno PL, López V, Hernández-Gallego R, Siverio O, Galeano C, Espí-Reig J, Cabezas CJ, Rodrigo MT, Llinàs-Mallol L, Fernández-Reyes MJ, Cruzado-Vega L, Pérez-Tamajón L, Santana-Estupiñán R, Ruiz-Fuentes MC, Tabernero G, Zárraga S, Ruiz JC, Gutiérrez-Dalmau A, Mazuecos A, Sánchez-Álvarez E, Crespo M, Pascual J. Use of tocilizumab in kidney transplant recipients with COVID-19. Am J Transplant 2020; 20:3182-3190. [PMID: 32654422 PMCID: PMC7405397 DOI: 10.1111/ajt.16192] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023]
Abstract
Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin-6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in patients with coronavirus disease 2019 (COVID-19) . In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (hazard ratio [HR] 3.12 for those older than 60 years, P = .039). IL-6 and other inflammatory markers, including lactic acid dehydrogenase, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in nonsurvivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in nonsurvivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [confidence interval 1.004-1.024], P = .003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration and did not have an impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.
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Affiliation(s)
- María J. Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain,Correspondence María J. Pérez-Sáez
| | - Miquel Blasco
- Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain
| | - Dolores Redondo-Pachón
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney, Transplantation Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, REDinREN (RD16/0009/0023), Barcelona, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Edoardo Melilli
- Department of Nephrology, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Luis A. Sánchez-Cámara
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Cristina Canal
- Department of Nephrology, Research Support Unit, Fundació Puigvert, Barcelona, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Verónica López
- Department of Nephrology, Hospital Regional Universitario, Universidad de Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | | | - Orlando Siverio
- Department of Nephrology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Cristina Galeano
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jordi Espí-Reig
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carlos J. Cabezas
- Department of Nephrology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - María T. Rodrigo
- Department of Nephrology, Hospital Universitario Donostia, Donostia, Spain
| | - Laura Llinàs-Mallol
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | | | | | - Lourdes Pérez-Tamajón
- Department of Nephrology, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Raquel Santana-Estupiñán
- Department of Nephrology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María C Ruiz-Fuentes
- Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Sofía Zárraga
- Department of Nephrology, Hospital de Cruces, Bilbao, Spain
| | - Juan C Ruiz
- Department of Nephrology, Hospital de Valdecilla, University of Cantabria, IDIAL, Santander, Spain
| | | | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, REDinREN (RD16/0009/0013), Barcelona, Spain
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