Way Stations in Progress — Burgeoning Treatment Options for IgA Nephropathy

IgA nephropathy, once considered a benign condition, is now recognized as the most common glomerulopathy worldwide, often progressing to end-stage kidney disease. Despite decades of symptomatic care, recent advances have led to new therapeutic options, including sodium-glucose cotransporter 2 inhibitors, targeted-release budesonide (Nefecon), and dual endothelin-angiotensin receptor antagonists (sparsentan).

Emerging trials have introduced additional promising treatments, such as:

- Sibeprenlimab — a humanized IgG2 monoclonal antibody, targeting APRIL (a proliferation-inducing ligand).

- Iptacopan — an alternative complement pathway inhibitor, showing significant reductions in proteinuria, but requiring further data on kidney function decline.

- Atrasentan — a selective endothelin type A receptor antagonist, demonstrating proteinuria reduction, but awaiting confirmation of renal progression impact.

The editorial emphasizes that trials using surrogate end points (e.g., proteinuria reduction) are predictive but require long-term validation with hard clinical end points (e.g., eGFR). It also advocates for head-to-head comparisons between new treatments to determine the most effective therapeutic approach.

IgA nephropathy, once considered a benign condition, is now recognized as the most common glomerulopathy worldwide, often progressing to end-stage kidney disease. Despite decades of symptomatic care, recent advances have led to new therapeutic options, including sodium-glucose cotransporter 2 inhibitors, targeted-release budesonide (Nefecon), and dual endothelin-angiotensin receptor antagonists (sparsentan).

Emerging trials have introduced additional promising treatments, such as:

- Sibeprenlimab — a humanized IgG2 monoclonal antibody, targeting APRIL (a proliferation-inducing ligand).

- Iptacopan — an alternative complement pathway inhibitor, showing significant reductions in proteinuria, but requiring further data on kidney function decline.

- Atrasentan — a selective endothelin type A receptor antagonist, demonstrating proteinuria reduction, but awaiting confirmation of renal progression impact.

The editorial emphasizes that trials using surrogate end points (e.g., proteinuria reduction) are predictive but require long-term validation with hard clinical end points (e.g., eGFR). It also advocates for head-to-head comparisons between new treatments to determine the most effective therapeutic approach.