1. Primary results of the randomized trial of metformin administration in polycystic kidney disease (TAME PKD)
- Author
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Christina M. Lalama, Peter C. Harris, Ronald D. Perrone, Cheng Tao, Stephen L. Seliger, Kaleab Z. Abebe, Terry Watnick, Kyongtae T. Bae, Kenneth R. Hallows, Dana C. Miskulin, and Andrew D. Althouse
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,030232 urology & nephrology ,Autosomal dominant polycystic kidney disease ,Urology ,Renal function ,Kidney ,urologic and male genital diseases ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Polycystic kidney disease ,Humans ,Adverse effect ,Cysts ,urogenital system ,business.industry ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,Metformin ,030104 developmental biology ,Tolerability ,Nephrology ,Disease Progression ,business ,Glomerular Filtration Rate ,medicine.drug - Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by growth of kidney cysts and glomerular filtration rate (GFR) decline. Metformin was found to impact cystogenesis in preclinical models of polycystic disease, is generally considered safe and may be a promising candidate for clinical investigation in ADPKD. In this phase 2 two-year trial, we randomly assigned 97 patients, 18-60 years of age, with ADPKD and estimated GFR over 50 ml/min/1.73 m2, in a 1:1 ratio to receive metformin or placebo twice daily. Primary outcomes were medication safety and tolerability. Secondary outcomes included estimated GFR decline, and total kidney volume growth. Thirty-eight metformin and 39 placebo participants still received study product at 24-months. Twenty-one participants in the metformin arm reduced drug dose due to inability to tolerate, compared with 14 in the placebo arm (not significant). Proportions of participants experiencing serious adverse events was similar between the groups. The Gastrointestinal Symptoms Rating Scale score was low at baseline and did not significantly change over time. The annual change for estimated GFR was -1.71 with metformin and -3.07 ml/min/1.73m2 per year with placebo (mean difference 1.37 {-0.70, 3.44} ml/min/1.73m2), while mean annual percent change in height-adjusted total kidney volume was 3.87% in metformin and 2.16% per year in placebo, (mean difference 1.68% {-2.11, 5.62}). Thus, metformin in adults with ADPKD was found to be safe and tolerable while slightly reducing estimated GFR decline but not to a significant degree. Hence, evaluation of efficacy requires a larger trial, with sufficient power to detect differences in endpoints.
- Published
- 2021