The recent approval of vadadustat (Vafseo) by the FDA for the treatment of chronic kidney disease (CKD)-related anemia in adults who have been on dialysis for at least 3 months marks a significant advancement in the field of nephrology. This development offers a new therapeutic option for individuals with CKD-related anemia, particularly those undergoing maintenance dialysis. The drug, developed by Akebia Therapeutics, has the potential to effectively increase and maintain hemoglobin concentrations within guideline-recommended target ranges.
Vadadustat is a once-daily, oral hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor. It works by activating the physiologic response to hypoxia, stimulating the endogenous production of erythropoietin to manage anemia. This mechanism of action sets vadadustat apart from traditional treatments for CKD-related anemia, which have typically involved the use of IV or injectable erythropoiesis-stimulating agents.
Akebia’s journey to obtaining FDA approval for vadadustat was not without its challenges. The company had previously faced a setback when the FDA rejected its initial application for a broader indication for CKD-related anemia. The agency cited concerns about the data supporting a favorable benefit-risk assessment of vadadustat for both dialysis and non-dialysis patients. However, following additional research and data from the INNO2VATE program, vadadustat demonstrated noninferiority to darbepoetin alfa in maintaining hemoglobin levels.
Clinical Efficacy and Safety
The findings from the INNO2VATE program revealed that vadadustat was comparable to darbepoetin alfa in terms of efficacy for maintaining hemoglobin concentrations in both incident and prevalent dialysis-dependent CKD patients. However, a cardiovascular safety signal emerged in non-dialysis-dependent CKD patients, highlighting the importance of monitoring for adverse reactions and side effects.
Common adverse reactions associated with vadadustat treatment included hypertension and diarrhea, occurring in at least 10% of patients. The drug’s label includes a boxed warning about the increased risk of death, myocardial infarction, stroke, venous thromboembolism, and thrombosis of vascular access. Additionally, warnings about hepatotoxicity, hypertension, seizures, gastrointestinal erosion, and malignancy are highlighted. It is crucial to note that vadadustat should not be used in patients with uncontrolled hypertension or as a substitute for red blood cell transfusions in cases requiring immediate correction of anemia.
The approval of vadadustat represents a significant milestone in the treatment of CKD-related anemia, offering a new oral therapeutic option for patients on dialysis. However, healthcare providers must remain vigilant about monitoring patients for adverse reactions and side effects, particularly in those with non-dialysis-dependent CKD. Further research and surveillance will be needed to assess the long-term safety and efficacy of vadadustat in clinical practice.