Chronic kidney disease (CKD) refers to a set of heterogenous disorders that affect the structure and function of the kidneys. The CKD drug market comprises a wide variety of antihypertensive agents and SGLT-2 inhibitors, which are intended to delay the progression of kidney damage. RAAS inhibitors are standard-of-care therapy for CKD. In 2021, AstraZeneca’s SGLT-2 inhibitor Farxiga (dapagliflozin) became the first SGLT-2 drug to demonstrate a renoprotective effect in a dedicated renal outcomes trial and to receive formal label approval from the FDA for the treatment of CKD irrespective of the presence or absence of diabetes. Other SGLT-2 inhibitors such as Eli Lilly’s Jardiance (empagliflozin) and Johnson & Johnson’s Invokana (canagliflozin) also demonstrated renoprotective benefits in diabetic patients with CKD in the EMPA-REG and CREDENCE trials. This drug class is heavily prescribed to patients with diabetic kidney disease and is set to play an increasingly important role in CKD treatment. Bayer’s Kerendia (finerenone), a mineralocorticoid receptor antagonist, has shown substantial renal benefits in CKD patients with diabetes; clinical trials of finerenone in nondiabetic CKD patients are ongoing. Supported by insights from thought leaders, we analyze the challenges associated with marketing drugs to treat an increasingly dynamic and complex disease.
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