Finerenone: Towards better cardio- vascular and renal protection in chronic kidney disease associated with type 2 diabetes

Johann Morelle, Nathalie Demoulin, Michel Jadoul Published in the journal : March 2023 Category : Actualité thérapeutique

The kidney is undoubtedly a major target for microvascular damage in diabetes, and approximately half of patients with type 2 diabetes develop chronic kidney disease. The presence of chronic kidney disease increases the risk of death, cardiovascular events, and progression to kidney failure, which may require dialysis or transplantation. For diabetic patients, these complications obviously have a major impact, both on their outcomes and quality of life.

Reimbursed in Belgium since February 1, 2023, finerenone (Kerendia®, Bayer) is a novel non-steroidal mineralocorticoid receptor antagonist that has recently been shown to be effective in preventing cardiovascular events and the progression of chronic kidney disease in type 2 diabetes patients.

This review summarizes the current state of knowledge and provides clinicians with the necessary tools to prescribe finerenone to patients at high cardiovascular and renal risk, who require holistic and multidisciplinary management.

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Some novelties in the 2021 recommendations for the management of dyslipidemia in cardiovascular prevention

Olivier S. Descamps (1), Fabian Demeure (2), Ann Mertens (3), Ann Verhaegen (4), Michel Langlois (5), Caroline Wallemacq (6), Ernst Rietzschel (7) au nom du Belgian Atherosclerosis Society/Belgian Lipid Club Published in the journal : March 2023 Category : Actualité thérapeutique

In terms of treatment decision-making for dyslipidemia, the new 2021 European recommendations for the prevention of atherosclerotic cardiovascular diseases provide some nuances compared to the previous 2019 recommendations. These nuances notably concern the use of a new primary prevention risk assessment based on more recent epidemiological data and some changes in risk classification: the SCORE2. Changes include the use of non-HDL cholesterol rather than total cholesterol to estimate the risk, as well as a risk expressed as morbi-mortality rather than mortality alone as previously. Changes in risk thresholds to categorize patients as being at “very high”, “high”, or “low-to-moderate” risk also better identify younger patients who may benefit from cardiovascular prevention early enough to avoid cardiovascular problems that may occur in their 50s or 60s. Conversely, in elderly patients, the cardiovascular risk classification has been revised upwards so as not to treat these more drug-sensitive patients aggressively. The recommendations are also timely to better define the use of new molecules that have been introduced in Belgium during the year 2022.

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Bempedoic acid: a new therapeutic option to improve the lipid profile of patients at high cardiovascular risk

Olivier S. Descamps1, Fabian Demeure2, Ann Mertens3, Ann Verhaegen4, Jean-Luc Balligand5, Michel Langlois6, Caroline Wallemacq7, Johan De Sutter8, Nathalie Cals,9 Ernst Rietzschel10 ***On behalf of the Belgian Society of Atherosclerosis/Belgian Lipid Club Published in the journal : March 2022 Category : Actualité thérapeutique

Low-density lipoprotein cholesterol (LDL-C) is now unequivocally considered a causal factor in atherosclerotic cardiovascular disease (ASCVD), and its reduction significantly contributes to preventing the risk of ASCVD.

Statins, ezetimibe, and proprotein convertase subtilisin/kexin Type 9 (PCSK9) inhibitors are the main treatment options available to date, but these drugs’ tolerability, adherence, and reimbursement remain problematic. Furthermore, despite these treatments, a large number of patients with high- and very high cardiovascular risk, are often unable to achieve the recommended LDL-C target levels. Hence, additional new treatments, whether given alone or in combination, are urgently required.

Owing to its mode of action that differs from that of other lipid-lowering therapies, along with its good safety profile, bempedoic acid constitutes the first candidate of a new and interesting therapeutic class for managing hypercholesterolemia. We have herein reviewed the currently available data relating to this drug’s efficacy and safety profile and similarly discussed its potential place in clinical practice, particularly in patients at high and very high cardiovascular risk who are insufficiently treated under ezetimibe along with a maximally tolerated statin or in those who display statin intolerance or contraindications.

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Semaglutide (Rybelsus®) – first GLP-1 receptor agonist available as oral formulation

Michel P. Hermans Published in the journal : January 2022 Category : Actualité thérapeutique

Oral semaglutide (Rybelsus®) is a new formulation of semaglutide for oral administration of this GLP-1 receptor agonist (GLP1-RA). Oral semaglutide, recently marketed in Belgium, is indicated for the treatment of hyperglycemia in poorly controlled adult Type 2 diabetics (T2DM) (HbA1c >7.5%) while taking metformin, with or without insulin. Phase 3 studies with active comparators or placebo demonstrated oral semaglutide’s sustained efficacy in reducing HbA1c and body weight in diabetic patients that were representative of the natural T2DM history, requiring the progressive stepping-up of glucose-lowering therapies. A prospective cardiovascular outcome trial recently confirmed the safety of this new semaglutide formulation.

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Atrial fibrillation and diabetes: role of direct oral anticoagulants

Cédric Hermans, Martin Buysschaert Published in the journal : March 2021 Category : Actualité thérapeutique

Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia, and this condition constitutes a major indication for oral anticoagulant therapy. NVAF is particularly common in diabetic patients, who are at greater risk of developing thrombotic or bleeding complications. Direct oral anticoagulants (DOACs) are progressively replacing vitamin K antagonists (VKAs) among patients with NVAF. They are as effective as VKAs in reducing the risk of cerebral and systemic embolic events, while simultaneously decreasing severe and cerebral bleedings. Several recent studies have demonstrated DOACs to provide the same benefits in terms of efficacy and safety in diabetic versus non-diabetic subjects with NVAF. As suggested by the results of the ENGAGE AF-TIMI 48 study, among the DOACs, edoxaban given to diabetic NVAF patients appears to be associated with a significantly decreased risk of severe bleeding complications compared with VKAs.

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Rivaroxaban (Xarelto®): Update on new clinical data and therapeutic perspectives

Cédric Hermans Published in the journal : October 2020 Category : Actualité thérapeutique

Direct oral anticoagulants (AODs), which target coagulation Factors Xa or IIa, represent a major therapeutic innovation. Even if classical anticoagulants, such as vitamin K antagonists (AVK) and low molecular weight heparins, still play a crucial role in preventive or curative treatment, AODs have revolutionized the medical management of thrombotic diseases, concerning both arterial and venous conditions.

In addition to being able to replace conventional anticoagulants in common indications like atrial fibrillation and venous thromboembolic disease, there is a plethora of Xarelto data from recent and original studies, as well as from registries and Phase III sub-analyses, which are currently revolutionizing the modalities and benefits of oral anticoagulation at all stages of life and in a wide spectrum of indications.

This article provides a synthetic and practical review of these data and their therapeutic implications.

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Semaglutide (Ozempic®), a new weekly GLP- 1 analogue for the treatment of type 2 diabetes mellitus

Michel P. Hermans Published in the journal : July 2019 Category : Actualité thérapeutique

Semaglutide is a GLP-1 analogue recently marketed in Belgium for the treatment of hyperglycaemia in patients with type 2 diabetes, by weekly subcutaneous administration. Among GLP-1 receptor agonists, semaglutide, at a maintenance dose of 0.5 or 1.0 mg/week, is currently the most effective compound for reducing chronic hyperglycaemia and body weight, as monotherapy or in combination with other hypoglycaemic medications, including basal insulin. The SUSTAIN 6 study also suggests a clinical benefit at the cardiovascular level. The tolerance and safety of semaglutide are comparable to those of other GLP-1 receptor agonists currently available in Belgium

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Biotherapies in the management of moderate-to-severe psoriasis

Deborah Debois, Marie Baeck, Pierre-Dominique Ghislain (1) Published in the journal : May 2019 Category : Actualité thérapeutique

Psoriasis, a very common systemic inflammatory disease, is potentially disabling from a functional and aesthetic point of view. In recent years, treatments for managing moderate- to-severe psoriasis have significantly evolved since the advent of biologic therapies. Undoubtedly, these latter have favorably impacted the patient quality of life.

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Degludec (Tresiba®): a new ultra-long acting basal insulin analog

Michel P. Hermans, Vanessa Preumont (1) Published in the journal : May 2019 Category : Actualité thérapeutique

Insulin degludec (Tresiba®) is an ultra-long acting basal insulin analog recently marketed in Belgium. Controlled clinical trials have demonstrated that insulin degludec provides similar reductions in HbA1c compared to the basal analogs glargine or detemir in Type 1 and Type 2 diabetes, with superior fasting glucose control in the majority of studies. The data additionally show a clinically relevant reduction in the incidence of hypoglycemia episodes, especially at night. The results of controlled and observational studies point towards the therapeutic added value of degludec in the management of Type 1 and Type 2 diabetes.

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Canagliflozin (Invokana®) associated with exemplary nephro- and cardioprotection in Type 2 diabetes. Synopsis of the CREDENCE study

Martin Buysschaert Published in the journal : May 2019 Category : Actualité thérapeutique

The CREDENCE study sought to compare the efficacy of canagliflozin vs. placebo in preventing clinically-relevant kidney and cardiovascular events in patients with diabetes and established kidney disease. With regard to the primary endpoint (terminal kidney failure; doubling of creatinine; renal or cardiovascular death), the authors reported a 30% reduction in the relative risk (hazard ratio [HR]: 0.70; 95% CI: 0.59-0.82, p=0.00001) after 2.6 years of follow-up. The risk was reduced by 17-39% with regard to secondary cardiovascular or renal endpoints. These results should be integrated in our therapeutic approach for Type 2 diabetes patients, in terms of both nephro- and cardioprotection.

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