Kidney Week

Abstract: PUB344

Sparsentan (SPAR) in Combination with a SGLT2 Inhibitor (SGLT2i) and Steroid as First-Line Treatment for IgA Nephropathy (IgAN): A Case Report

Session Information

• Publication Only

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Goshtaseb, Ray Reza, UCLA, Department of Medicine, Nephrology Division, Los Angeles, California, United States

Ray Reza Goshtaseb, MD, FASN

• Pelts Block, Agness, Travere Therapeutics, Inc., San Diego, California, United States

Agness Pelts Block, MD

• Gisler, Christopher, Travere Therapeutics, Inc., San Diego, California, United States

Christopher Gisler, MD

Introduction

SPAR is a nonimmunosuppressive, dual endothelin angiotensin receptor antagonist (DEARA) approved in the US and EU for the treatment of adults with IgAN at risk of rapid disease progression. Early clinical experience from a limited number of patients suggests that an SGLT2i added to SPAR is generally well tolerated and may have additive benefit on proteinuria reduction in IgAN. However, the use of SPAR in combination with an SGLT2i in the first-line setting has not been evaluated in a clinical trial. We present a case of SPAR + SGLT2i + steroid combination therapy as a first-line treatment for IgAN.

Case Description

A 51-year-old Asian woman with biopsy-proven IgAN presented with substantial proteinuria (24-h urine protein excretion [UPE] of 10.9 g/d), gross hematuria, an estimated glomerular filtration rate (eGFR) of 61 mL/min/1.73 m², and slightly elevated blood pressure (BP) at diagnosis. She is receiving SPAR (400 mg/d; dose increased after 2 weeks at 200 mg/d) in combination with the SGLT2i dapagliflozin (10 mg/d) and a tapering dose of prednisone (60 to 5 mg). All medications were initiated simultaneously following diagnosis. After 6 mo, proteinuria was markedly reduced (UPE of <0.5 g/d), eGFR and BP improved, and hematuria resolved (Table). The combination treatment was well tolerated, with no safety concerns; liver function tests were stable and within normal limits.

Discussion

This case supports the efficacy and safety of SPAR in combination with an SGLT2i and steroid in the first-line setting, highlighting a rapid reduction in proteinuria despite high levels at treatment initiation, together with improvement in kidney function and resolution of hematuria with the combination treatment.

Clinical Assessments at Baseline and Follow-up

BP, blood pressure; eGFR, estimated glomerular filtration rate; UPE, urine protein excretion.