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Combination Therapy Provides Improved Reductions in Proteinuria: Presented at ASN By Bryan DeBusk, PhD SAN FRANCISCO, CA -- November 5, 2007 -- Combination therapy with angiotensin-receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors produces a 24% average reduction in proteinuria among patients with Chronic Kidney Disease according to a meta-analysis of randomised parallel and crossover trials. Johannes Mann, MD, Department of Nephrology & Hypertension, Schwabing General Hospital, Munich, Germany, reported the findings here at Renal Week 2007, the American Society of Nephrology (ASN) Annual Meeting. In an examination of 49 trials including 6,181 patients in 72 short-term (4-month) and 38 long-term (5- to 12-month) comparisons of ARBs, ACE inhibitors, and combinations of the two, the study confirmed the utility of both classes of therapy in reducing proteinuria. The reductions were similar for both groups (ARBs Ratio of Means [RoM] 0.99; 95% confidence interval [CI] 0.92-1.05; and ACE-inhibitors RoM 1.08; 95% CI 0.96-1.22), and the effects were independent of degree of protein excretion (ie, microalbuminuria or proteinuria) and diabetic status. Patients receiving both therapies experienced an additional reduction beyond that observed with a single therapy both in the short term (compared with ARBs RoM 0.76; 95% CI 0.68-0.85; compared with ACE inhibitors RoM 0.78; 95% CI 0.72-0.82) and the long term (compared to ARBs RoM 0.75; 95% CI 0.61-0.92; compared with ACE inhibitors RoM 0.82; 95% CI 0.67-1.01). Other studies presented at the conference indicate that the benefit of the individual therapies may be increased safety with larger doses. Responding to a question from the audience about whether the study found any indication that increased dose for a single drug would be better than the combination, Dr. Mann responded, "We did this mainly to look at the effects of the combination because... for the single [therapy] studies, the effects were very variable... These data are easily transferable to what you can do with your patients." [Presentation Title: Best Option for Proteinuria Control: Angiotensin-Receptor Blockers - ACE-Inhibitors or Both? A Meta-Analysis. Abstract SA-FC040] E-mail this page to a friend or colleague! To print, use this version