Mavik (trandolapril) is an angiotensin-converting-enzyme (ACE) inhibitor, marketed by AbbVie, this is approved to treat high blood pressure and heart failure. Mavik may also be prescribed off-label to people with Alport syndrome as a first-line therapy to treat proteinuria (protein in the urine) and kidney disease.
How Mavik works
Mavik blocks the activity of the angiotensin-converting-enzyme (ACE), which is involved in the production of the hormone angiotensin 2. This hormone can raise blood pressure by narrowing blood vessels and increasing water retention. By preventing ACE from working, angiotensin 2 levels are reduced. This should allow blood vessels to relax and blood pressure to fall.
High blood pressure can damage the blood vessels that travel through the kidneys, causing them to be less effective in filtering waste products from the blood. This can lead to proteins or blood passing through the glomeruli — or filtration unit — in the kidneys, and be excreted in the urine as a waste product.
In Alport syndrome, the glomeruli in the kidneys are damaged due to a mutation in one of the genes encoding for an important structural protein called type 4 collagen. As a result, the kidneys cannot filter the blood as effectively as they should. Lowering blood pressure can prevent additional damage, helping to maintain kidney function.
Angiotensin 2 can also stimulate the release of an immune protein called TGF-β, which can contribute to scarring and kidney damage. Here, too, Mavik may have a protective effect on the kidneys, slowing damage by preventing its release.
Mavik in clinical trials
No clinical trials have evaluated Mavik’s use and its possible benefits specifically in Alport syndrome patients. However, it has been assessed as a therapy for kidney problems associated with other conditions.
For example, a randomized, double-blind Phase 4 clinical trial (NCT00235014) called BENEDICT looked at the effect of Mavik or verapamil/trandolapril in preventing kidney disease in 281 patients with type 2 diabetes over a two-year period. The progression of kidney disease was determined by albuminuria, or the presence of the protein albumin in the urine, which is an early sign of kidney disease as it suggests the kidneys are struggling to filter the blood well. Results, published in the Journal of Hypertension in 2000, found that Mavik returned albuminuria levels to normal in about half of treated patients.
The most common side effects of Mavik include coughing, dizziness, and low blood pressure.
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