Unmet Needs In Managing IgAN

Chee Kay Cheung, MBCHB, MRCP, PhD: There are several unmet needs currently in the treatment of patients with IgA [immunoglobulin A] nephropathy. The UK Renal Registry study that I mentioned before demonstrates that patients with the decline of kidney function of more than 1 mL/min per year will be at risk in their lifetime of developing kidney failure. Current therapies are available to us are unable to slow down kidney function decline to this extent. So we desperately need new therapies to target this condition that are also safe and effective to be used in the long term. I think in order to achieve this target of reducing kidney function decline down to less than 1 mL/min per year, in the future we’re likely to need a combination of therapies that can be used at different times [over] a patient’s disease course. Fortunately, we now have 2 therapies that have been approved specifically for IgA nephropathy, targeted-release budesonide and sparsentan. We have SGLT2 inhibitors, and over 20 other new drugs are being developed in IgA nephropathy that target B-cell production of IgA, that targets the complement system, the endothelin system, and other pathways as well. Hopefully we’ll see a number of these new and promising treatments being approved over the next few years. But as well as slowing disease progression down to this target, I think there still remain several unmet needs, especially in populations that haven’t been studied in trials so far. For example, how do we best treat children with IgA nephropathy? How do we treat the related condition, IgA nephropathy vasculitis, and how do we best treat those with low levels of kidney function who have been so far excluded from clinical trials? For example, those with an eGFR [estimated glomerular filtration rate] of less than 30 mL/min? And, importantly, how do we treat IgA nephropathy that occurs after kidney transplantation? I think there’s still a lot of work to be done.

Transcript is AI-generated and edited for clarity and readability.