Brad Rovin, MD

"Most people need something more,” Brad Rovin, MD, professor of nephrology at the Ohio State University Wexner Medical Center, said in an interview with 

 treatment stands today, even with a wave of new therapies on the market, including why so many patients are still undertreated, what he expects from the future of kidney biopsy, and where he thinks the field is dropping the ball on diagnosis.

Closing Gaps in IgA Nephropathy Diagnosis and Treatment, With Brad Rovin, MD

Q&A: What's Still Missing in IgA Nephropathy Care, With Brad Rovin, MD

Despite increased awareness and new treatment options, what challenges or misconceptions about IgAN management do you think still need to be addressed?

Rovin: A lot of the community still doesn't really appreciate that this disease is, in most patients, progressive, and ultimately, over a long span, will result in chronic kidney disease or end stage kidney disease. Folks are still content to start therapy with simply RAS inhibition, despite the plethora of new approaches available, because it's worked in the past for some people. The real problem is we don't know who needs only that therapy and who needs something more. My opinion is that most people need something more, because when we see IgA patients in our clinic, they almost all have diminished kidney function. So I don't think RAS inhibition alone is enough. We need to start very much characterizing our patients, and hopefully we'll learn who can get away with very little therapy, but the majority really will need something else. Knowing that upfront, when you start working with a patient, is vitally important.

: Kidney biopsy remains central to the diagnosis of IgAN. As our understanding of disease biology evolves, how do you see the role of pathology changing in guiding prognosis and treatment decisions?

Rovin: I am very much a biopsy in favor person. I think we can learn a lot from the tissue. We have ways to go in IgAN, but a lot of what we're doing now in nephropathology is looking at the molecular underpinnings of disease. Eventually we'll have to understand how to translate what's going on at the molecular level in tissue into something that can be utilized clinically right away, because doing transcriptomics and proteomics on tissue takes time, and you don't want to delay diagnosis or treatment. This is where we're going in the pathology space. Another newish field of pathology is called pathomics, which is really exciting. It uses machine learning to look at all the little things in the pathology and structure of the kidney that we can't see with our eye, like the thickness of a basement membrane or how the podocytes are laying in the glomeruli. These may also influence results of therapy or how the kidney progresses over time. There's a lot happening now in pathology that will increase the utility of the biopsy in the future.

HCPLive: Are there any treatment approaches or strategies in IgAN that you think are currently underappreciated in clinical practice or deserve more attention from clinicians?

Rovin: I think the rollout has been sort of the first line therapies that got approved a couple years ago, and I don't know that they're underappreciated. I do think the exciting new therapies are the drugs targeting B cells, and again, I don't think they're underappreciated, but we have to educate people well on their potential. A lot of people are reluctant to think about them, maybe because they're not used to depleting or modifying B cell function, and they're worried about that for IgAN. But they would have no second thoughts about doing it for a lupus patient. So there's some education needed there. I do think these therapies are going to have a big uptick now that there are two approved,1,2 and I think they'll really benefit our patient population.

: What is one change you hope to see in IgAN care over the next few years?

Rovin: I would like to see us being able to make the diagnosis much sooner than we have been doing. I think that's going to take the nephrology community working with primary care physicians and our urology colleagues to refer patients who have a little bit of blood in their urine, a little bit of protein, earlier than they do, and not dismiss those clinical findings as urinary tract infections or something else. I think that will get us to where we want to be, because earlier therapy is beneficial for most people.

Iapoce C. FDA approves atacicept for IgA nephropathy. AJMC. August 2026. Accessed August 11, 2026. 

https://www.ajmc.com/view/fda-approves-atacicept-for-iga-nephropathy

A second B cell drug for IgA nephropathy was approved in July and two more FDA decisions are due by December. Medical Daily. July 2026. Accessed August 11, 2026. 

https://www.medicaldaily.com/iga-nephropathy-atacicept-approval-fda-decisions-2026-476696

Articles

IgA nephropathy is still underrecognized as a predominantly progressive disease, leaving many patients managed with RAAS inhibition alone despite frequent presentation with already diminished kidney function. The central unmet need is early risk stratification to identify who requires escalation beyond supportive care. Kidney biopsy will remain pivotal, but its value may expand through molecular profiling and “pathomics” using machine learning to quantify subvisual structural features linked to prognosis and treatment response. B‑cell–targeted therapies are poised to increase adoption, alongside earlier referral to avoid delayed diagnosis.

Brad Rovin, MD, discusses persistent gaps in IgA nephropathy diagnosis and treatment, from RAS inhibition limits to the promise of B-cell-targeted therapies.

What's Still Missing in IgA Nephropathy Care, With Brad Rovin, MD

Despite increased awareness and new treatment options for

, clinicians still face challenges identifying which patients need more than first-line therapy and diagnosing the disease early enough to prevent long-term kidney damage, according to Brad Rovin, MD, professor of nephrology at the Ohio State University Wexner Medical Center.

, Rovin outlined ongoing challenges in IgAN management, the evolving role of kidney biopsy, and where he sees the field moving over the next several years.

Why RAS Inhibition Alone May Not Be Enough for Many Patients With IgAN

Rovin noted that IgAN is, for most patients, a progressive disease that can ultimately lead to 

 or end-stage kidney disease, but he suggested this reality is still not widely appreciated across the clinical community. Many clinicians remain comfortable initiating treatment with renin-angiotensin system (RAS) inhibition alone, an approach that has been used for years and has worked for some patients.

“I think most people need something more, because when we see IgA patients in our clinic, they almost all have diminished kidney function,” said Rovin.

He explained that the central challenge is identifying which patients can be adequately managed with RAS inhibition alone and which require additional therapy. Rovin said the field needs to move toward more detailed characterization of individual patients early in the course of care to identify those who may need minimal intervention and, more importantly, flag those who likely require more intensive treatment. He emphasized that knowing which patients need additional therapy upfront is vitally important.

Pathology Could Expand the Role of Kidney Biopsy in IgAN

Rovin described himself as strongly in favor of biopsy-based diagnosis, noting that tissue analysis remains central to understanding IgAN. He pointed to ongoing work in nephropathology examining the molecular underpinnings of the disease, with an eventual goal of translating molecular-level findings into clinically actionable information without delaying diagnosis or treatment, since transcriptomic and proteomic analyses remain time-intensive.

He also highlighted an emerging area of pathology known as pathomics, which applies machine learning to examine structural features in kidney tissue that may be difficult to assess visually, such as basement membrane thickness or podocyte architecture within the glomeruli. According to Rovin, these features may eventually help predict treatment response or disease progression, further expanding the clinical utility of biopsy in IgAN.

Therapies Targeting B-Cell Pathways Could Gain Ground in IgAN

Rovin's comments come as 2 therapies targeting pathways involved in B-cell function have become available for IgAN: sibeprenlimab (Voyxact), approved in November 2025, and atacicept (Trutakna), which received FDA accelerated approval on July 7, 2026, to reduce proteinuria in adults with primary IgAN at risk for disease progression.

Rovin said these newer therapies could see increased use now that 2 such agents are approved, and he believes they could provide meaningful benefit for patients with IgAN.

He noted some clinician reluctance to consider therapies that target B-cell pathways in IgAN, saying some nephrologists may be less familiar with modifying B-cell function in this setting despite using similar approaches in diseases such as lupus nephritis.

“They would have no second thoughts about doing it for a lupus patient,” said Rovin, adding that education about these therapies and their potential role in IgAN will be important as their use expands.

Earlier Referral Could Improve Long-Term IgAN Outcomes

Looking ahead, Rovin said his primary hope for the field is earlier diagnosis. He pointed to the need for closer collaboration between nephrology, primary care, and urology to ensure that patients presenting with mild hematuria or proteinuria are referred for further evaluation rather than having those findings attributed to a urinary tract infection or another cause.

“I think that will get us to where we want to be, because earlier therapy is beneficial for most people,” said Rovin.

Editor’s Note: Rovin reports relevant disclosures with AstraZeneca, Aurinia Pharmaceuticals, Biogen, Eli Lilly and Company, GlaxoSmithKline (GSK), Genentech/Roche, Pfizer, Novartis, and others.

Videos

Brad Rovin, MD, discusses gaps in IgA nephropathy care, biopsy's expanding role, and how new B cell therapies are reshaping treatment.

The Future of CAR-T in Lupus Nephritis Treatment, With Brad Rovin, MD

The emergence of CAR-T cell therapy in lupus nephritis has generated significant excitement, but questions remain around how and when this intensive approach should be used. While early studies have focused on patients with refractory disease, the broader clinical vision may extend much earlier in the disease course, particularly as safety and feasibility continue to improve.

 at at the World Congress of Nephrology (WCN) Conference in Yokohama, Japan, Brad Rovin, MD, said the current emphasis on refractory populations reflects regulatory caution, ensuring that higher-risk therapies are first tested in patients with limited alternatives. However, he suggests this approach may not fully capture the therapy’s potential.

Check out part 1 of the interview with Rovin 

Patients with longstanding, treatment-resistant disease often have accumulated, irreversible damage, which may limit the likelihood of achieving full recovery. In contrast, he envisions a future where CAR-T therapy could be used earlier, potentially at the time of diagnosis, to alter the disease trajectory before significant organ damage occurs.

He emphasizes that this shift could be particularly meaningful for the predominantly young patient population affected by lupus nephritis, as conventional treatment regimens often involve prolonged immunosuppression, multiple medications, and significant side effects, all of which can disrupt education, careers, and family planning. If CAR-T therapy can be delivered safely and efficiently, it may offer the possibility of durable remission with reduced long-term treatment burden.

Despite this promise, Rovin notes that logistical barriers remain. Current autologous CAR-T approaches require harvesting and engineering a patient’s own cells, a process that can take weeks and may necessitate holding background immunosuppression. This delay, along with the need for hospitalization, complicates real-world implementation. Looking ahead, he highlights the potential of allogeneic, “off-the-shelf” CAR-T products designed to evade immune rejection, which could streamline delivery and enable outpatient administration.

He also points to emerging alternatives, such as bispecific antibodies that engage T cells without requiring cell harvesting. While these agents may offer greater convenience, they still carry risks such as cytokine release syndrome and require careful evaluation.

Ultimately, he underscores that the future of CAR-T therapy will depend on advances in precision medicine. Identifying which patients are most likely to benefit and aligning treatment strategies with patient preferences will be critical. As the evidence base rapidly expands, he stresses the importance of shared decision-making and continued clinical investigation to define the optimal role of these therapies in lupus care.

Relevant disclosures for Rovin include Biogen, GSK, Genentech/Roche, BMS, Travere, Alexion, Novartis, AstraZeneca, Otsuka, Calliditis, and others.

 Allogeneic anti-CD19 CAR-T cells induce remission in refractory systemic lupus erythematosus. 

https://doi.org/10.1038/s41422-025-01128-1

Hsieh EWY, Chung JB, Amin A, et al. Key considerations for advancing chimeric antigen receptor (CAR) T-cell therapy for systemic lupus erythematosus (SLE): a multi-partner/disciplinary working group perspective. 

https://doi.org/10.1136/rmdopen-2025-005866

CAR-T therapy in lupus may shift earlier in care, but challenges in access, logistics, and patient selection remain as the field moves toward precision treatment.

Can CAR-T Cell Therapy Transform Lupus Nephritis Care? With Brad Rovin, MD

The treatment of lupus nephritis has long been challenged by profound disease heterogeneity and incomplete responses to standard immunosuppressive therapies. Despite recent advances and newly approved agents, many patients still fail to achieve complete remission. Against this backdrop, the emergence of CAR-T cell therapy represents a potentially transformative step, rooted in the field’s broader shift toward precision medicine and deeper immune modulation.

 at the World Congress of Nephrology (WCN) Conference in Yokohama, Japan, Brad Rovin, MD, explains how the field has historically relied on broadly acting immunosuppressive approaches, such as high-dose cyclophosphamide or mycophenolate, which “treat everything” but fail to account for the biological variability across patients. He says that this one-size-fits-all strategy is increasingly being replaced by efforts to tailor therapy more precisely, particularly as it has become clear that more than half of patients do not achieve complete clinical remission with existing options.

“I think with the idea of using something like a CAR-T cell, we borrow a lot of things from oncology, there's no question about it,” he said. “The idea was, could we affect the immune system in a way that renders it less likely to attack in an autoimmune way for some prolonged period of time? I'm hesitant to use the word cure, because I don't know that we've established cure yet. I think the CAR-T data show that we can, in some patients, achieve a prolonged drug free response. Whether that is a cure in some people, we'll see.”

A key differentiator, Rovin explains, lies in the depth and breadth of B-cell targeting. Unlike conventional anti-CD20 therapies like obinutuzumab (Gazyva), which target a narrower subset of B cells, CAR-T therapies directed at CD19 affect a broader range of the B-cell lineage, including antibody-producing populations. He highlights that CAR-T therapy also appears to induce more complete depletion within lymphoid tissues, including germinal centers, which may be critical for sustained disease control and may go beyond what is achieved with current therapies.

He describes the most striking findings to date as reports of sustained clinical remission lasting up to 4 years without ongoing immunosuppression. However, he emphasizes that these results are not universal, and the therapy carries significant risks, including profound immunosuppression and potential toxicities.

Looking ahead, Rovin stresses the importance of careful patient selection, transparent communication, and continued clinical investigation. While CAR-T therapy may represent a paradigm shift in lupus care, defining its long-term role and balancing its promise with its risks will be essential as the field moves forward.

“I think now it's up to us to continue the investigations, which are ongoing, and now trials are enrolling pretty well and and try to sort these issues out, but like any new therapy, there's going to be bumps, and I think that this is important to think about when we talk to our patients and families about this,” he said.

Editors’ Note: Relevant disclosures for Rovin include Biogen, GSK, Genentech/Roche, BMS, Travere, Alexion, Novartis, AstraZeneca, Otsuka, Calliditis, and others.

Brooks A. FDA Approves Obinutuzumab (Gazyva) for Lupus Nephritis. RheumatologyLive. October 20, 2025. Accessed March 29, 2026. 

https://www.rheum-live.com/view/fda-approves-obinutuzumab-gazyva-for-lupus-nephritis

Musa R, Rout P, Qurie A. Lupus Nephritis. StatPearls. January 16, 2025. Accessed March 29, 2026. 

https://www.ncbi.nlm.nih.gov/books/NBK499817/

CAR-T therapy shows potential for deep, durable remission in lupus nephritis, but questions remain on safety, durability, and patient selection.