New Drugs for IgAN Offer Promise of Better Outcomes

BY JOHN SCHIESZER

ALTHOUGH immunoglobulin A nephropathy (IgAN) remains incurable, clinicians can now offer patients treatments that can reduce proteinuria and potentially improve outcomes, according to a presentation at the National Kidney Foundation’s Spring Clinical Meetings in Austin, Texas.

Most recently, in February, the FDA granted accelerated approval to sparsentan (Filspari), the first non-immunosuppressive medication for treating adults with primary IgAN. In 2021, budesonide delayed-released capsules (Tarpeyo), an immunosuppressive therapy, received an FDA-approved indication for reducing proteinuria in patients with IgAN.

“For the first time, we have FDAapproved medications for the treatment of IgAN and there are clinical targets to reduce proteinuria as a means of preserving GFR [glomerular filtration rate],” said Sharon Adler, MD, of CKD, Farxiga’s approval for CKD would extend to IgAN,” Dr Adler said. Sparsentan is an endothelin and angiotensin II receptor antagonist and is only available through a restricted distribution program called FILSPARI Risk Evaluation and Mitigation Strategies (REMS). Some endothelin receptor antagonists have caused elevations of aminotransferases, hepatotoxicity, and liver failure. With this agent, measuring liver aminotransferases and total bilirubin prior to initiation of treatment is required.

“Clinicians in the US can take a more proactive position in diagnosing IgAN earlier in its course so that we can treat patients earlier,” Dr Adler said. “From a research perspective, a simple diagnostic test would be a great breakthrough. Applying precision medicine principles to treatment is the next big challenge: the right drug for the right patient at the right time.” ■

Professor of Medicine at the David Geffen School of Medicine at the University of California in Los Angeles (UCLA). Dr Adler is an investigator at the Lundquist Research Institute at Harbor-UCLA Medical Center, where she is a practicing nephrologist, and Editor-in-Chief of Glomerular Diseases.

Speaking at a session on IgAN management, Dr Adler said managing IgAN presents a variety of challenges, especially staying up to date with the contemporary understanding of the disease state. New and emerging treatment options are significantly changing the treatment landscape.

“It is an exceptionally exciting time to be a nephrologist these days, since we have so many new and emerging treatment options for our patients,” Dr Adler said.

In addition to budesonide and sparsentan, clinicians also have in their armamentarium dapagliflozin (Farxiga), a sodium-glucose cotransport-2 (SGLT2) inhibitor originally approved in 2014 for treating type 2 diabetes but in 2021 received approval to prevent disease progression in patients with chronic kidney disease (CKD). “Since IgAN falls under the umbrella