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

Updated: May 19, 2020
  • 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. [38]  

The phase 2b NEFIGAN trial demonstrated a 24% decrease in mean UPCR in patients receiving a novel targeted-release formulation of oral budesonide that delivers the drug to the distal ileum, thus targeting the Peyer patches; this agent is twice as potent as prednisone. Mean UPCR of participants was 1.2 g/day and mean eGFR was 78 mL/min/1.73 m2. Budesonide 16 mg/day, added to optimized renin-angiotensin system blockade, reduced proteinuria by around 25-30% compared with placebo. Patients in the treatment group experienced an increased rate of steroid-related events including acne, hypertension, cushingoid features, mood swings, and hirsutism. The authors conclude that the results support the hypothesis that mucosal immune dysfunction has a significant role in the pathogenesis of IgA nephropathy. [39]  A phase 3 trial of targeted-release budesonide, the NefigArd trial, is currently in progress.


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