Drug repurposing for glomerular diseases: an underutilized resource

Drug repurposing in glomerular disease can deliver opportunities for steroid-free regimens, enable personalized multi-target options for resistant or relapsing disease and enhance treatment options for understudied populations (for example, children) and in resource-limited settings. Identification of drug-repurposing candidates can be data driven, which utilizes existing data on disease pathobiology, drug features and clinical outcomes, or experimental, which involves high-throughput drug screens. Information from databases of approved drugs, clinical trials and PubMed registries suggests that at least 96 drugs on the market cover 49 targets with immunosuppressive potential that could be candidates for drug repurposing in glomerular disease. Furthermore, evidence to support drug repurposing is available for 191 immune drug target-glomerular disease pairs. Non-immunological drug repurposing includes strategies to reduce haemodynamic overload, podocyte injury and kidney fibrosis. Recommended strategies to expand drug-repurposing capacity in glomerular disease include enriching drug databases with glomeruli-specific information, enhancing the accessibility of primary clinical trial data, biomarker discovery to improve participant selection into clinical trials and improve surrogate outcomes and initiatives to reduce patent, regulatory and organizational hurdles. Drug repurposing could expand the therapeutic options available to patients with glomerular disease. Here, the authors examine different approaches to the identification of drug candidates, consider current immunosuppressive and non-immunological options and discuss strategies to maximize drug repurposing in glomerular disease. Drug repurposing can improve the treatment of glomerular disease by providing steroid-free regimens, enabling options for resistant or relapsing disease, enhancing treatment options for understudied populations and increasing therapy options in resource-limited settings.Contemporary methods of identifying drug-repurposing candidates can be data driven or experimental.At least 96 drugs on the market have targets with immunosuppressive potential that could be candidates for repurposing for glomerular disease treatment.Non-immunological drug repurposing for glomerular disease involves strategies to reduce haemodynamic overload, podocyte injury and kidney fibrosis.Strategies to expand drug-repurposing capacity need to enrich datasets with glomeruli-specific information, enhance the accessibility of clinical trial data, improve biomarker discovery and address patent, regulatory and organizational hurdles.