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Polycystic Kidney Growth Not Stopped by Sirolimus

Everolimus slows total kidney volume increase but not progressive renal injury decline

MONDAY, June 28 (HealthDay News) -- Sirolimus does not stop polycystic kidney growth in individuals with autosomal dominant polycystic kidney disease (ADPKD) and early chronic kidney disease; everolimus, however, slows the increase in total kidney volume but does not slow the decline in progressive renal impairment in those with ADPKD, according to two studies published online June 26 in the New England Journal of Medicine to coincide with press conferences at the European Renal Association—European Dialysis and Transplant Association Congress, held from June 25 to 28 in Munich, Germany.

Andreas L. Serra, M.D., of the University Hospital and the University of Zurich in Switzerland, and colleagues randomized 100 patients with ADPKD and early chronic kidney disease between the ages of 18 and 40 years to receive sirolimus (target dose, 2 mg daily) or standard care, finding no significant difference in total kidney volume after 18 months of treatment with sirolimus.

In a two-year double-blind study, Gerd Walz, M.D., of the University Hospital in Freiburg, Germany, and colleagues randomized 433 patients with ADPKD to everolimus or placebo. The researchers found that the increase in total kidney volume from baseline to one and two years was lower in the everolimus group versus the placebo group. However, everolimus was not associated with a slowing in the decline in progressive renal impairment.

"Taken together, these studies suggest that therapy with these mammalian target of rapamycin inhibitors will not be the sought-after magic bullet, regardless of ADPKD stage," write the authors of an accompanying editorial.

The Serra study was supported in part by Wyeth (now Pfizer). In addition, Wyeth Switzerland (now Pfizer) provided sirolimus, and GE Healthcare Switzerland provided equipment; several authors disclosed financial ties to these and other pharmaceutical and medical device companies. The Walz study was supported by Novartis.

Abstract - Serra
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Abstract - Walz
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