Recently I had 2 patients with biopsy-proven IgA Nephropathy for which treatment options have gained much attention over the past years. One patient has a high fibrosis index and the other has low fibrosis and >1g proteinuria.
Clinical trials addressing this condition are bringing us hope where, not too long ago, limited options where commonplace. Last month, the ISN Global trial focus highlighted the "Protect Trial" (check the link bellow)
Now sparsentan seems to be gaining momentum with the outlook of sustained proteinuria reduction in a 2 year follow-up study (compared to irbesartan). Once this drug is still not available in my country (and budesonide - NefIgArd is also difficult to access), I'm still prone to use corticosteroids in those with low fibrosis index (Testing trial) and SGLT2i in my patients where a more conservative approach is required. Research on selective antagonists of mineralocorticoids is also taking place. The Spartacus study will explore the combination of SGLT2-i and sparsentan.
The discussion on what action to take as a first step promises to gain attention in the nephrology community. How are you approaching your patients with IgA Nephropathy?
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