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An update on corticosteroid treatment for IgA nephropathy
Malak Ghaddar1,2, Jonathan Barratt3, Sean J Barbour1,2
1Division of Nephrology, University of British Columbia.
Current Opinion in Nephrology and Hypertension
|March 3, 2023
Summary
New corticosteroid regimens and targeted-release budesonide offer improved treatment options for IgA nephropathy (IgAN), showing reduced kidney function decline and proteinuria with better safety profiles.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- Corticosteroid use in IgA nephropathy (IgAN) is debated due to uncertain efficacy and safety concerns.
- Recent clinical trials aim to clarify the benefits and risks of corticosteroid therapy in IgAN management.
Approach:
- The TESTING trial evaluated reduced-dose methylprednisolone against placebo in IgAN patients, after optimizing supportive care.
- A phase III trial assessed a novel targeted-release budesonide formulation for IgAN, leading to accelerated FDA approval.
- Subgroup analysis of the DAPA-CKD trial explored sodium-glucose transport protein 2 inhibitors in IgAN patients.
Key Points:
- Reduced-dose methylprednisolone significantly lowered the risk of estimated glomerular filtration rate (eGFR) decline, kidney failure, and kidney death in IgAN patients.
- Steroid treatment also led to a sustained reduction in proteinuria compared to placebo.
- Targeted-release budesonide demonstrated significant short-term proteinuria reduction.
- Sodium-glucose transport protein 2 inhibitors showed potential in reducing kidney function decline for specific IgAN patient groups.
Conclusions:
- Reduced-dose corticosteroids and targeted-release budesonide represent new therapeutic avenues for high-risk IgA nephropathy.
- Ongoing research focuses on developing novel therapies with enhanced safety profiles for IgAN treatment.
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