Embracing Newer Agents in IgAN

Opinion
Video

An expert nephrologist shares his opinion on newer treatments of IgAN such as budesonide and SGLT2 inhibitors, commenting that patients with greater disease progression stand to benefit the most from these treatments.

Chee Kay Cheung, MBCHB, MRCP, PhD: Steroids have been used for a long time in IgA nephropathy, and there were some early trials that demonstrated benefits. But I think the issue with glucocorticoids in IgA [immunoglobulin A] nephropathy is the significant [adverse] effects and their toxicity in the long term, especially in terms of bone health and in terms of increasing cardiovascular risk. Steroids were treated were studied in a primarily Caucasian population in the STOP-IgAN trial, which took place in several centers in Germany. And in that study there was no long-term benefit seen in terms of kidney outcomes over follow-up out to a 7- or 8-year period. We did see potential beneficial effects in the testing study, which compared methylprednisolone compared to placebo in a primarily Asian population. But, again, that benefit seemed to be temporary in that those effects by 3 years were lost compared [with] placebo. And, importantly, the methylprednisolone-treated arm also experienced a higher number of adverse effects compared [with] placebo. So I think…newer agents such as budesonide and SGLT2 inhibitors are interesting. I think SGLT2 inhibitors are being used more and more in all forms of chronic kidney disease. And I think patients that stand to benefit most perhaps are those with more advanced forms of kidney disease who have evidence of irreversible scarring or those with high levels of proteinuria. Regarding targeted-release budesonide, the label that’s coming from the FDA and the EMA [European Medicines Agency] is for those with a high level of proteinuria with the UPCR [urine protein creatinine ratio] above 1.5 g/g, which are [the] patients at the highest risk of disease progression. So I think those [patients] with higher levels of proteinuria, and more preserved levels of kidney function, may benefit most from this therapy.

Transcript is AI-generated and edited for clarity and readability.

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