Positioning Emerging B-Cell Modulators in Future IgAN Treatment Algorithms

In this segment, the panel discusses how B-cell modulators such as atacicept, sibeprenlimab, and povetacicept may fit within evolving treatment pathways for IgA nephropathy. They emphasize that optimized supportive care—including maximized RAAS inhibition, SGLT2 inhibitors, blood pressure control, and dietary sodium restriction—remains foundational. However, they note that persistent proteinuria despite these measures should prompt consideration of disease-modifying therapy. The panel explains that B-cell modulators may be positioned earlier in the treatment algorithm than traditional systemic corticosteroids because they target upstream pathogenic processes rather than broadly suppressing immunity. They also discuss differentiation among agents, including dosing schedules, biomarkers used to track response, and potential safety considerations. The discussion highlights that future treatment strategies may involve pairing supportive therapy with early initiation of a B-cell modulator, rather than reserving disease-modifying treatment only for advanced or rapidly progressive disease. Overall, the panel anticipates that these agents will shift practice toward earlier, mechanism-based intervention.