Aceon (perindopril) is an ACE inhibitor approved by the U.S. Food and Drug Administration (FDA) to treat high blood pressure and coronary artery disease. It is manufactured by many companies and can be used to delay the onset of kidney failure in Alport syndrome patients.
How Aceon works
Aceon works by inhibiting the effect of the angiotensin-converting enzyme (ACE), which normally converts a hormone called angiotensin 1 into another hormone called angiotensin 2. Angiotensin 2 is a vasoconstrictor — an agent that causes blood vessels to narrow, increasing blood pressure.
Angiotensin 2 also breaks down a protein called bradykinin, which acts to dilate blood vessels. Degrading bradykinin causes blood vessels to constrict, which also increases blood pressure.
Angiotensin 2 also stimulates the release of a hormone called aldosterone. This hormone causes the kidney to increase the production of proteins that transport sodium and water out of urine before it is excreted, increasing blood volume and blood pressure.
Perindopril, the active ingredient of Aceon, is a pro-drug; once ingested, it is metabolized by the liver to its active form, which is called perindoprilat. Perindoprilat competes for the active site of ACE. ACE enzymes that are bound to perindoprilat are not available to bind to angiotensin 1 and convert it to angiotensin 2.
By inhibiting the production of angiotensin 2, Aceon helps decrease blood pressure in several ways. In Alport syndrome, this may decrease the strain on the kidneys, delaying the onset of kidney failure.
Aceon in clinical trials
Although Aceon has not been tested in controlled clinical trials specifically in Alport syndrome patients, it is among the ACE inhibitors recommended as first-line treatments of the condition.
The effects of the treatment on patients with kidney disease due to other conditions continue to be assessed in clinical trials.
For example, a clinical trial — the results of which were published in The British Medical Journal —studied the effect of Aceon on high blood pressure in patients with diabetes and symptoms of kidney malfunction measured by the presence of protein in the urine. Patients were randomly assigned to receive either Aceon (20 patients) or nifedipine (a calcium channel blocker, 23 patients) for 12 months, and were monitored for one to three months after the treatment period.
Some patients in each group had high blood pressure at the beginning of the study; others did not. High blood pressure correlated with the presence of protein in the urine. Both treatments decreased blood pressure and protein levels in the urine. For patients with normal blood pressure, neither treatment decreased protein levels in the urine, but kept it at the same level.
A Phase 4 clinical trial (NCT03502031) is currently recruiting 164 patients with diabetic nephropathy (kidney disease due to diabetes) in Georgia. Patients stably being treated with either an ACE inhibitor (Aceon, lisinopril, or enalapril) or an angiotensin receptor blocker (ARB) such as Cozaar (losartan) or Diovan (valsartan) are being monitored. Half the patients will be treated with spironolactone in addition to their other medication. Urine tests will be used to monitor levels of protein throughout the trial.
Aceon is usually well-tolerated and has similar side effects to other ACE inhibitors, which may include dizziness, cough, and back pain.
Aceon is not recommended for patients who are pregnant as it may cause injury or death to the fetus.
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