Targeted-release budesonide: A comprehensive review on its potential in IgA nephropathy

IgA nephropathy (IgAN) is characterized by the presence of IgA deposits in the glomerular mesangium, representing a prevalent form of primary glomerulonephritis worldwide. This condition is associated with a significant risk of progression to end-stage renal disease (ESRD). Hypertension, proteinuria, and reduced glomerular filtration rate (GFR) are established risk factors. Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are currently the first-line treatments, they do not adequately mitigate the risk of disease progression. Budesonide is a potent corticosteroid that has been utilized for many years in the treatment of inflammatory diseases. Recently, a novel formulation, targeted-release budesonide (TRF-budesonide), was developed to facilitate drug release specifically in the distal ileum to treat IgAN. This review synthesizes the existing evidence on the impact of TRF-budesonide in IgAN, covering its pathogenesis, efficacy, and safety. It also explores comparisons between TRF-budesonide and other therapeutic options, highlighting the advantages of TRF-budesonide in reducing proteinuria and preserving renal function. While TRF-budesonide has demonstrated promising efficacy and safety in short- and medium-term studies, showcasing its potential as a valuable treatment option for IgAN, further high-quality randomized controlled trials are needed to comprehensively evaluate its long-term efficacy and safety. Such research will pave the way for more personalized and precise treatment options for patients with IgAN.