What is the efficacy of immunosuppressive therapy for immunoglobulin A (IgA) nephropathy?

Updated: Feb 15, 2018
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

A 2015 Cochrane review of immunosuppressive therapy for IgA nephropathy concluded that corticosteroid therapy may lower risks of kidney disease progression, proteinuria, doubling of serum creatinine, and need for dialysis or transplantation. However, the review concluded that the optimal management of IgA nephropathy remains uncertain, and larger controlled trials are needed. [34]  

The phase 2b NEFIGAN trial demonstrated a 24% decrease in mean urinary protein:creatinine ratio in patients receiving a novel targeted-release formulation of oral budesonide that delivers the drug to the distal ileum, thus targeting the Peyer patches. Budesonide 16 mg/day, added to optimized renin-angiotensin system blockade, reduced proteinuria by around 30% compared to placebo. The authors conclude that the results support the hypothesis that mucosal immune dysfunction has a significant role in the pathogenesis of IgA nephropathy. [35]


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