Future of IgAN Treatment and Clinical Pearls for Disease Management

Chee Kay Cheung, MBChB, MRCP, PhD: Well, I think for a long time we’ve not really had many effective therapies to choose from in IgA [immunoglobulin A] nephropathy [IgAN]. We’ve had ACE [angiotensin-converting enzyme] inhibitors and angiotensin receptor blockers, but not much else. But suddenly we have 2 newly approved therapies for IgA nephropathy specifically, that’s targeted-release budesonide and sparsentan. And suddenly we also have 20 other new therapies that are in clinical development and hopefully will be able to have…some of these that can be used in the near future. I think working out exactly which treatment would be suitable for an individual patient about the specific time in that disease course will be the next challenge. And it could mean that a combination of therapies would be most effective, and I think there will need to be studies to look into that.… There’s more exciting translational work to be done in IgA nephropathy as well. And the good news is that all the phase 2 and phase 3 trials are conducting by repository sample collections as well, so we may be able to get clues from this about which patients are more likely to respond to a particular therapy or not. And we may be able to look at samples in order to develop biomarkers that can assess the degree of responsiveness to treatment or indeed to disease prognosis.

I think you have to bear in mind that while in most patients with IgA nephropathy these things happen quite gradually over a number of years, IgA nephropathy is a progressive disease that will progress to kidney failure in the majority unless we can slow the rate of kidney function loss significantly. I think, fortunately, we have new and exciting therapies that are coming and [we are] continuing to enroll [patients] into ongoing clinical trials that will ensure…we can deliver these therapies to our patients in the future.

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