Another drug for blocking RAAS!

A combination of aliskiren and losartan reduced albuminuria in patients with type 2 diabetes and nephropathy — at least in the short term.

Aliskiren is an oral renin inhibitor recently approved for marketing in the U.S. In the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) trial, a double-blind, randomized, placebo-controlled study sponsored by the manufacturer of aliskiren, investigators explored whether combining aliskiren with losartan, an angiotensin-receptor blocker, would be renoprotective in patients with type 2 diabetes. After a 3-month, open-label run-in period, patients with type 2 diabetes, hypertension, and proteinuria who were receiving losartan (with or without other antihypertensive agents that do not block the renin-angiotensin-aldosterone system) were assigned to receive additional aliskiren (150 mg/day for 3 months, 300 mg/day thereafter) or placebo for 6 months. The primary outcome of interest was reduction of albuminuria.

Baseline characteristics and the proportions of patients receiving glucose-lowering or lipid-lowering drugs and aspirin were similar in the two groups. At 6 months, the mean urinary albumin-to-creatinine ratio was about 20% lower in the aliskiren group than in the placebo group (P<0.001); p="0.07," p="0.08," href="http://content.nejm.org/cgi/reprint/358/23/2433.pdf">NEJM article.