OR WAIT null SECS
New Guidelines and Novel Therapies in IgA Nephropathy, With Jai Radhakrishnan, MD
Radhakrishnan breaks down the recent KDIGO IgAN guidelines and describes the evolving therapeutic landscape of IgA nephropathy.
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.
Advances in the understanding of its complex pathogenesis and the arrival of targeted therapies are reshaping how clinicians diagnose and manage this rare glomerular disease. However, significant challenges remain, particularly around early detection and timely referral, as many patients continue to present with advanced kidney dysfunction.
“Unfortunately, there's no guideline that mandates yearly checking of the urine for protein or blood in a healthy population,” Jai Radhakrishnan, MD, a nephrologist and professor at Columbia University Irving Medical Center, explained to HCPLive. “As a consequence, patients are missed during the early stages of the disease, where treatment, if available, could have modified the course of the disease.”
Radhakrishnan goes on to describe the growing recognition surrounding the importance of early referral and early diagnosis. After decades of what he describes as a “famine” in IgAN treatments, he says clinicians finally have options to offer their patients.
He says the approach to early diagnosis and treatment was recently “codified” in new guidelines from Kidney Disease: Improving Global Outcomes (KDIGO). In the document, KDIGO encourages a more liberal kidney biopsy policy, suggesting it should be considered in all adults with proteinuria ≥0.5 g/d in whom IgAN is suspected. Regarding treatment, proteinuria reduction goals were reduced to <0.5 g/d while on or off treatment of IgAN, ideally <0.3 g/d (or equivalent), and a stable estimated glomerular filtration rate.
Radhakrishnan also describes the guideline’s focus on treatments that aim to (i) prevent or reduce IgA-containing immune complex (IgA-IC) formation and IgA-IC–mediated glomerular injury and (ii) manage the consequences of existing IgAN-induced nephron loss.
Regarding recent advances in IgAN therapeutics, Radhakrishnan reflects on the availability of treatments that target the known drivers of the disease as well as treatments that control response of proximal pathways of inflammation, including targeted release budesonide, iptacopan, sparsentan, and atrasentan. Looking ahead, he predicts that B cell inhibitors currently in phase 3 clinical trials will eventually enter the therapeutic landscape and provide yet another treatment option, also noting complement inhibitors other than iptacopan currently in the pipeline.
“In a year, 2 years, or 3 years from now, the whole field is going to be radically different in terms of the choices available for treating our patients with IgA nephropathy,” Radhakrishnan said.
Editors' Note: Radhakrishnan reports relevant disclosures with Vertex, Travere, Amgen, Glaxo Smith Kline, Novartis, Vera Therapeutics, Sanofi, and others.
