Prolyl-hydroxylase inhibitors for the treatment of anemia in chronic kidney disease

• Published in: Current opinion in nephrology and hypertension Vol. 28; no. 6; pp. 600 - 606
• Main Authors: McMahon, Gearoid M, Singh, Ajay K
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc. All rights reserved 01-11-2019
• Subjects: Administration, Oral; Anemia - drug therapy; Erythropoiesis; Erythropoietin - physiology; Humans; Hypoxia-Inducible Factor-Proline Dioxygenases; Intracellular Signaling Peptides and Proteins - physiology; Kidney Failure, Chronic - drug therapy; Mitochondrial Proteins - physiology; Prolyl-Hydroxylase Inhibitors - therapeutic use; Renal Insufficiency, Chronic - complications
• ISSN: 1062-4821; 1473-6543
• DOI: 10.1097/MNH.0000000000000554

PURPOSE OF REVIEWProlyl-hydroxylase inhibitors are a novel class of orally administered drugs that are under development for the treatment of anemia in patients with chronic kidney disease. This review discusses the biology of these drugs and their target – hypoxia-inducible factor and potential advantages and disadvantages of these therapies. Finally, we will discuss current trials in patients with both chronic kidney disease and end-stage renal disease.
RECENT FINDINGSRecent smaller studies have found that prolyl-hydroxylase are as effective as erythropoietin in treating anemia of chronic kidney disease. We do not yet know if they have the same cardiovascular and cancer-related risk profile and these questions will be answered by large phase III trials that are ongoing.
SUMMARYAlthough prolyl hydroxylase inhibitors have much potential, questions remain regarding their efficacy and safety. Should these concerns prove to be unfounded, the treatment of anemia in chronic kidney disease will likely be transformed over the next decade.