Introduction
IgAN is the most common pattern of primary glomerular disease worldwide and remains a leading cause of chronic kidney disease and kidney failure. Most commonly, IgAN is asymptomatic and follows a slowly progressive course with approximately 25–30% of any cohort developing kidney failure within 20–25 years of presentation.
The management of IgAN encompasses rigorous blood pressure control, optimal inhibition of the renin-angiotensin system, and lifestyle modification. Evolving insights into the mechanisms driving this disease have led to the approval of a targeted-release formulation of budesonide, the first and currently only treatment approved specifically for IgAN.
Although IgAN is characterized by a single histopathologic criterion of predominant or codominant IgA deposits on kidney biopsy, its marked heterogeneity of clinical and pathological features is now well-recognized.
Reference: Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1–S276.
IgA Nephropathy (IgAN), also known as Berger’s disease, is the most prevalent form of primary glomerular disease worldwide and remains a major contributor to the development of chronic kidney disease and kidney failure. In many cases, IgAN does not present with noticeable symptoms and progresses slowly over time, with around 25-30% of patients experiencing kidney failure within 20-25 years of initial diagnosis. Although IgAN is characterized by the presence of IgA deposits in the kidneys during biopsy, it is now well-acknowledged that the disease exhibits significant heterogeneity in its clinical and pathological features.
The management of IgAN involves strict control of blood pressure, optimal inhibition of the renin-angiotensin system, and making necessary lifestyle modifications. However, recent advancements in understanding the underlying mechanisms of IgAN have led to the approval of a targeted-release formulation of budesonide.
This promising treatment has shown significant improvements in patient outcomes such as effectively reducing proteinuria and stabilizing kidney function when compared to a placebo. This demonstrates its potential to address the primary manifestations of IgAN and the potential to delay the need for more aggressive interventions, such as immunosuppressive therapy or dialysis. This not only improves patients’ quality of life but also reduces the burden on healthcare systems.
Reference: Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1–S276. Ismail G, Obrişcă B, Jurubiţă R, Andronesi A, Sorohan B, Vornicu A, et al. Budesonide versus systemic corticosteroids in IgA Nephropathy: A retrospective, propensity-matched comparison. Medicine (Baltimore) [Internet]. 2020 [cited 2023 Jun 13];99(26):e21000. Available from: http://dx.doi.org/10.1097/md.0000000000021000
Faculty
Jonathan Barratt PhD FRCP
Learning Goal/Purpose
The goal of this activity is to increase clinicians’ knowledge and competency in IgAN diagnosis and evidence-based management strategies, in both primary diagnostic and post-transplant recurrence settings.
Learning objectives
After completing this educational activity, learners should be able to:
- Describe the immunopathophysiology of IgAN, exploring the role of the mucosal immune system in IgAN and how it may be leveraged to develop new treatments.
- List treatment options for adult patients with IgAN and provide an overview of their mechanism of action, efficacy and safety, and approved therapeutic indications (e.g, corticosteroids, B-cell-targeted immunomodulators, monoclonal antibodies, sodium-glucose cotransporter-2 [SGLT2] inhibitors)
- Explain how the targeted-release formulation of budesonide differs from other corticoids
- Discuss key efficacy and safety data, such as those of Nef301 study, Phase 2 NEFIGAN study, and the recently published Phase 3 NEFIGARD Part A data (with Part B results due in Q3 2023).
- Determine the most appropriate treatment strategy for an individual patient, by interpreting and applying guidelines, recommendations and algorithms for the diagnosis and treatment of IgAN, and considering patient characteristics, clinical factors, and the safety and efficacy of available agents.
- Monitor treatment response and list indications for continuing, modifying and stopping therapy, including follow-up recommendations.
Target Audience
This activity is intended for healthcare professionals who manage patients with IgAN, including nephrologists, immunologists, internal medicine specialists, and primary care physicians in Europe.
Accreditation statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and SEI Healthcare LLC. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.
Oakstone Publishing designates this activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.
After completion of this activity, you can obtain your CME credit by visiting the link on the Case Summary page.
Expiration dates
Upon completion of this activity, the deadline to complete the evaluation form to obtain CME credits is 14 June 2024.
Disclosures
Faculty
Jonathan Barratt PhD FRCP
Prof. Barratt has disclosed the following financial relationships:
Editor
Julia Granerod Whitehouse
Scientific Content Manager, SEI Healthcare
Dr Julia Whitehouse has disclosed the following financial relationships:
Medical writing and scientific consultancy: Takeda
CME Reviewer
Sandy Mardant, Oakstone Publishing – Director of Continuing Education
Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest have been mitigated. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relationships with ineligible companies.
Peer Reviewer
This activity has been peer-reviewed and the reviewer has disclosed no financial relationships.
