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Kidney Week

Abstract: FR-PO906

Sparsentan (SPAR) in Combination with SGLT2 Inhibitors (SGLT2i) in Patients with IgA Nephropathy (IgAN): A Case Series

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Ravipati, Prasanth, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Colbert, Gates, Texas A&M College of Medicine, Dallas, Texas, United States
  • Evans, Sarah Jane, DuBois Nephrology Associates, DuBois, Pennsylvania, United States
  • Pelts Block, Agness, Travere Therapeutics, Inc., San Diego, California, United States
  • Gisler, Christopher, Travere Therapeutics, Inc., San Diego, California, United States
  • Sothinathan, Renuka, Virginia Nephrology Group, Arlington, Virginia, United States
Introduction

SPAR is a nonimmunosuppressive, dual endothelin angiotensin receptor antagonist (DEARA) that is approved in the US and EU for adults with IgAN at risk of rapid disease progression. Previously reported evidence from a small number of pts with IgAN in the PROTECT open-label extension study support an additive benefit in proteinuria reduction with an SGLT2i added to SPAR, but evidence on the combination treatment in the real-world setting is limited. Here we report a series of 4 pts with IgAN receiving SPAR in combination with an SGLT2i.

Case Description

Four pts with biopsy-proven IgAN (aged 29-62 y) received SPAR (400 mg/d; dose increased from 200 mg/d after 2 weeks [or at closest follow-up visit]) in combination with the SGLT2i dapagliflozin. Individual case details are summarized in the Table. Three pts received prior steroid/immunosuppressive treatment (tx; alone or in combination with a renin-angiotensin system inhibitor [RASi]); 1 pt received a prior RASi (losartan) alone. Duration of follow-up on SPAR tx ranged from 3 to 7 mo, with all pts still receiving SPAR + SGLT2i combination tx at last follow-up. A decrease in proteinuria (urine protein-to-creatinine ratio [UPCR]) was seen in all pts regardless of eGFR at initiation. One pt achieved complete remission of proteinuria (UPCR <0.3 g/g) after 3 mo of SPAR + SGLT2i tx. In all pts, proteinuria improved to a greater extent with SPAR + SGLT2i than it had from diagnosis to the end of previous treatment. All pts had hematuria at SPAR initiation; it resolved in 1 pt after 8 mo on SPAR + SGLT2i. Blood pressure was generally stable with the combination tx. SPAR + SGLT2i tx was generally well tolerated, with no liver function test elevations.

Discussion

This case series supports the safety and efficacy of SPAR in combination with the SGLT2i dapagliflozin in pts with IgAN; improvements were observed in proteinuria regardless of eGFR or UPCR at SPAR initiation. Cases also highlight an additive benefit of SPAR, with greater proteinuria improvements achieved with SPAR + SGLT2i than previous treatment.