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Navigating Treatment Decisions In IgAN, With Jai Radhakrishnan, MD
Radhakrishnan emphasizes the importance of individualized IgAN care and how to best use currently available and emerging treatments.
Once known as a poorly understood disease with few effective treatment options, IgA nephropathy (IgAN) is now at the center of a rapidly evolving therapeutic landscape. As the treatment armamentarium continues to expand, so too does the complexity of clinical decision-making.
Recent guidelines from Kidney Disease: Improving Global Outcomes (KDIGO) introduced several important clinical changes regarding diagnosis and disease management, including a more liberal kidney biopsy policy and more stringent proteinuria reduction goals.
“The challenge really is to navigate the possibility of how best to treat the patient, given the data that's available,” Jai Radhakrishnan, MD, a nephrologist and professor at Columbia University Irving Medical Center, explained to HCPLive. “Every patient is different, and we have to look at nuances in a given patient to make treatment decisions. That's going to be the biggest challenge in the future.”
He goes on to emphasize urgent unmet needs regarding early diagnosis and referral to nephrology, also noting that managing IgAN effectively extends well beyond the initial presentation. As a lifelong disease, it often requires long-term reassessment and recalibration of treatment plans as patients age and as new therapies emerge. Radhakrishnan says questions remain about how often to adjust therapy or whether repeat biopsies might help guide management decisions over time.
“The other big elephant in the room is the cost of medications,” Radhakrishnan said.
With multiple targeted treatments entering the market and the potential of add on and combination therapy, he cautions that clinicians must carefully weigh the financial impact on both patients and the healthcare system. Radhakrishnan says preventing kidney failure and avoiding dialysis or transplant will offset long-term costs but notes that not all patients will respond equally to these advanced treatments.
“[The guidelines] give you an idea of how best to approach a given patient, but we as practitioners will ultimately need to make the final decision on how best to use these medications,” he concluded.
Editors’ note: Radhakrishnan reports relevant disclosures with Vertex, Travere, Amgen, Glaxo Smith Kline, Novartis, Vera Therapeutics, Sanofi, and others.
