Dr. Navdeep Tangri & Helen Yeh Shares Insights from the Data Presented at ASN Kidney Week 2022 on the Importance of Earlier Screening & Diagnosis of Chronic Kidney Disease

Shots:

Dr. Navdeep spoke about the data presented at the ASN Kidney Week 2022 emphasizing on the urgent need for early screening of chronic kidney disease
Helen Yeh talked about the treatment of CKD with Farxiga. She also focused on the patient support programs by AstraZeneca for the early diagnosis and screening of patients
The interview gives a profound understanding of Astrazeneca’s vision to advance its CVRM portfolio

Smriti: Let's start by discussing the epidemiology, risk factors, and prevention methods of chronic kidney disease.

Navdeep Tangri: CKD is common and affects 850 million people worldwide, and leads to considerable morbidity and health care costs. Diabetes and Hypertension are the two main risk factors for CKD, and screening with albuminuria in high-risk populations can lead to early intervention which can slow CKD progression and prevent dialysis.

Smriti: Shed some light on the data presented at the ASN Kidney Week 2022 focusing on earlier screening and diagnosis of chronic kidney disease (CKD)

Navdeep Tangri: The REVEAL-CKD trial focused on the diagnosis of CKD by a physician – when does it occur, how does it occur, and what are the implications of making the diagnosis. In a representative population of US adults, we found that diagnosis does not occur nearly half the time, and there is considerable diagnostic delay. More importantly, when it does happen, it leads to meaningful improvements in quality of CKD care, prescribing of disease modifying therapy, and is associated with a slowing of CKD progression.

Smriti: Please let us know the importance of early diagnosis of CKD. Do you think that early diagnosis can decline the growth rate of this disease?

Navdeep Tangri: Early diagnosis is the first step in improving the management of CKD. Diagnosis shines a spotlight on the kidney, and leads to the right processes, which may ultimately slow progression. Diagnosis alone is not enough but it can be a powerful trigger to make the right changes to benefit each patient’s kidney health.

Smriti: How do you think that the treatment with Farxiga can be a better treatment option for patients than the other existing treatments available in the market?

Helen Yeh: In the DAPA-CKD trial, dapagliflozin demonstrated a robust benefit on top of previous standard of care for all primary and secondary endpoints in the treatment of patients with CKD with and without T2D. This included a statistically significant and clinically meaningful 39% reduction in the primary composite endpoint of ≥50% sustained decline in eGFR, ESKD, renal death, or CV death. The absolute risk reduction was 5.3%, translating to one adverse outcome avoided for every 19 patients treated over a median of 2.4 years. Farxiga also demonstrated a statistically significant reduction of premature death and CV death or hospitalization by 31% and 29%, respectively. Dapagliflozin is the only treatment to demonstrate CV and mortality benefits in a dedicated CKD trial in patients with and without T2D, providing an important treatment option to ease the substantial burden of CKD. The robust benefits of Farxiga also extend to patients with heart failure, being the only SGLT2 inhibitor to demonstrate a clinically meaningful effect on mortality in patients across the range of left ventricular ejection fraction.

Smriti: DAPA-CKD study involved other CKD indications such as IgAN and C3G among others. Please share post-hoc analysis data for other indications beyond CKD.

Helen Yeh: DAPA-CKD studied the effects of Farxiga in a broad range of CKD patients with varying causes of their disease. A pre-specified analysis of DAPA-CKD assessed the effects of Farxiga by underlying causes of CKD, and the effects on the primary composite endpoint of ≥50% sustained decline in eGFR, ESKD, renal death, or CV death was consistent among patients with diabetic nephropathy (n=2510; HR, 0.63; 95% CI, 0.51-0.78), chronic glomerulonephritides (n=695; HR, 0.43; 95% CI, 0.26-0.71), ischemic/hypertensive nephropathy (n=687; HR, 0.75; 95% CI 0.44-1.26), and CKD of other/unknown cause (n=412; HR, 0.58; 95% CI, 0.29-1.19) p-interaction 0.53. Reduction in the secondary endpoints of CV death or hHF and all-cause mortality were also consistent, regardless of kidney disease cause. Consistent with the overall DAPA-CKD population, in the 270 patients with IgA nephropathy, Farxiga significantly reduced the risk of the primary composite endpoint (HR, 0.29; 95% CI, 0.12-0.73; p=0.005) and progression to ESKD (HR, 0.30; 95% CI, 0.11-0.83; p=0.014).

Smriti: Can we talk a little about Farxiga and how it helps to reduce healthcare costs?

Helen Yeh: Worldwide ~850 million people have CKD and the clinical and economic burden associated with CKD is increasing. The potential impact of Farxiga on healthcare costs vs previous standard of care was assessed using data from the DAPA-CKD trial and published event costs across 23 countries. This study demonstrated that across 100,000 patients treated with Farxiga, a 33% reduction in costs can be achieved, resulting in savings of $205M over a 3-year period. The authors concluded that Farxiga treatment in CKD has the potential to significantly reduce healthcare resource use through delayed CKD progression and reduced incidence of cardio-renal events and mortality.

Smriti: How is AstraZeneca supporting patients with CKD? Are there any patient support programs or digital initiatives by AstraZeneca for the early diagnosis and screening of patients?

Helen Yeh: AstraZeneca established the global ACT on CKD initiative to drive comprehensive partnerships across the healthcare ecosystem, including with professional societies, patient organizations, policy makers, diagnostic providers & healthcare decision makers to increase awareness of CKD, drive routine screening and early diagnosis, and ultimately reduce the risk of disease progression and complications. These collaborations have significantly advanced the CKD landscape via extensive education and awareness (e.g., “The Pressure is On” campaign), diagnostic enhancements (e.g. electronic medical records, point-of-care testing, etc.) and patient-centric reforms of worldwide policies and protocols. Since the start of ACT on CKD, our efforts have resulted in over 22 million patients screened globally and over 8 million diagnosed.

Source: Canva

About the Authors:

Dr. Navdeep Tangri

Dr. Navdeep Tangri is the Professor of Medicine at the University of Manitoba Department of Internal Medicine, Winnipeg, Manitoba, Canada from where he obtained his medical degree. Dr Tangri’s main research interest revolves around improving clinical decision-making for patients with advanced chronic kidney disease (CKD). His efforts in understanding CKD led to the development of the Kidney Failure Risk Equation (KFRE), used worldwide to predict the need for dialysis in patients with CKD. He is presently engaged in multiple validation and implementation exercises to increase the uptake of the KFRE.

Helen Yeh

Helen Yeh is the Vice President, CVRM Therapy Area Biopharmaceuticals Medical at AstraZeneca.Helen has been focused in the renal and heart failure disease areas, for example guiding products through worldwide approval and launch, working with real world databases to provide a holistic approach to evidence generation, shaping educational programs, and pioneering practice change initiatives in support of guideline-directed medical care. She earned her bachlors, masters and PhD in Pharmacology from The University of Manchester.