SGLT2 inhibitor approved as first new treatment for CKD in 20 years

Dapagliflozin (Forxiga) has been TGA approved to reduce the risk of worsening kidney function in adults with proteinuric chronic kidney disease.

Professor Carol Pollock, renal research lead at the Kolling Institute, Royal North Shore Hospital, said the new indication represents a significant milestone to better manage chronic kidney disease.

“It is promising to see new treatments have been proven to reduce the likelihood that patients with chronic kidney disease (CKD) will progress to dialysis, require kidney transplantation or suffer cardiovascular disease including heart attack, stroke or heart failure,” she said in a statement from AstraZeneca.

The TGA granted a priority review of Forxiga for people with chronic kidney disease following the pivotal DAPA-CKD study which was stopped early because of efficacy.

Professor Jonathan Shaw, Deputy Director of the Baker Heart and Diabetes Institute, said new treatments for chronic kidney disease will help drive better education on the interconnectedness with other chronic conditions, like type 2 diabetes.

“All the patients that I see with type 2 diabetes are at risk of chronic kidney disease due to the complex interplay between these chronic conditions. We need to be vigilant in recognising the early signs and drive early detection and diagnosis to achieve better outcomes for people with diabetes. By initiating treatment early it gives us an opportunity to slow down the progression of the disease and prevent some of the other related complications,” he said.

Monash researchers find key to insulin resistance

Mesenteric lymphatic dysfunction could contribute to and be a therapeutic target for insulin resistance and obesity, according to an Australian-led study.

The study — performed in pre-clinical models — showed that a high-fat diet can promote insulin resistance by stimulating the growth of highly-branched mesenteric lymphatic vessels that ‘leak’ fluid into visceral adipose tissue, Monash University Associate Professor of drug delivery disposition and dynamics Natalie Trevakis and her team wrote in Nature Metabolism.

Meanwhile, treatment with a lymph-targeted cyclooxygenase- (COX) 2 inhibitor helped normalise the lymphatic vasculature, reverse visceral obesity and inflammation and restore glycaemic control in mice, they wrote.

“In this study we were able to uncover for the first time a biological reason behind why the accumulation of fat around the abdomen is correlated with higher rates of metabolic disease such as type 2 diabetes than accumulation of fat in other regions of the body,” Associate Professor Trevaskis said in a statement.

“We were able to show that a high-fat diet leads to dysfunction of the mesenteric lymphatics, which in turn promotes more fat deposition around the abdomen and insulin resistance.”

“The results from ex vivo experiments using clinical samples suggest that these observations extend to humans as well,” she concluded.

COVID-19 vax boosters needed for some patients: ATAGI

A third COVID-19 vaccine booster dose will soon be recommended for some Australians with immunocompromising conditions, according to the Australian Technical Advisory Group on Immunisation (ATAGI).

In advice released on 23 September, ATAGI said it anticipated that “a relatively small cohort of individuals, such as those with severely immunocompromising conditions, are likely to require a third dose as part of their primary course of vaccination to ensure optimal vaccine effectiveness.”

ATAGI added that boosters for other populations may be required in the future, and it was preparing recommendations to be released in the next few weeks.

Factors to be considered in recommendations for boosters include the duration of protection provided by additional doses, timing of booster doses to cover anticipated future peaks and the balance of efficacy and safety of third doses of mRNA vaccines, it said. ATAGI is also reviewing the types of vaccine to be used as boosters and the potential for newer  types such as the protein subunit vaccines variant vaccines as they become available.

In the meantime it said first and second dose coverage remained a priority for achieving protection in the current Delta outbreak.