Kidney Week

Abstract: FR-PO893

Comparative Efficacy and Safety of New Therapies for IgA Nephropathy: A Systematic Review and Network Meta-Analysis

Session Information

• IgA Nephropathy: Clinical, Outcomes, and Therapeutics
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Lucena, Larissa Araújo de, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Larissa Araújo de Lucena, DrMed

• Cavalcante, Deivyd Vieira Silva, Universidade Federal do Maranhao, Sao Luis, MA, Brazil

Deivyd Vieira Silva Cavalcante

• Hespanhol, Larissa C., Universidade Federal de Campina Grande, Cajazeiras, PB, Brazil

Larissa C. Hespanhol

• Balieiro, Caroline Cristine Almeida, Universidade do Estado do Amazonas, Manaus, AM, Brazil

Caroline Cristine Almeida Balieiro

• Romeiro, Pedro, Centro Universitario de Maceio, Maceio, AL, Brazil

Pedro Romeiro

• Castro, Paulo de Coelho, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

Paulo de Coelho Castro, MD

• Ribeiro Gonçalves, Ocilio de Deus da Rocha, Universidade Federal do Piaui, Teresina, PI, Brazil

Ocilio de Deus da Rocha Ribeiro Gonçalves

• Rego, Rafael Andrade, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Rafael Andrade Rego

• Arruda de Oliveira, Antonio Lucas, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Antonio Lucas Arruda de Oliveira

• Costa Borges, Rafael, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Rafael Costa Borges, MD

• Santos Pinto, Luis Claudio, Centro Universitario da Amazonia, Belem, Brazil

Luis Claudio Santos Pinto, MD, MSc

• de Oliveira, Rodrigo Azevedo, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Rodrigo Azevedo de Oliveira, MD, PhD

Background

Immunoglobulin A nephropathy (IgAN) can lead to progressive renal dysfunction. This network meta-analysis evaluated novel therapies targeting IgAN's mechanisms, comparing their efficacy and safety to standard care, aiming to optimize clinical management based on current evidence.

Methods

We evaluated 11 randomized controlled trials involving 861 IgAN patients published in the past 10 years. A Bayesian network meta-analysis compared the efficacy of various treatments against placebo, using mean differences and SUCRA values. We searched PubMed, Embase, and Cochrane Central databases to identify studies evaluating primary outcomes: Urine Protein/Creatinine Ratio (UPCR) and estimated Glomerular Filtration Rate (eGFR) change over time.

Results

Mycophenolate (0.754), Atacicept (0.724), and Hydroxychloroquine (0.686) ranked highest in SUCRA values for UPCR reduction. Mycophenolate significantly reduced proteinuria with a mean difference of −0.59 (95% CrI: −1.7, 0.55). Atacicept and Hydroxychloroquine had mean differences of −0.50 (95% CrI: −1.4, 0.38) and −0.46 (95% CrI: −1.6, 0.62). Iptacopan and Budesonide showed limited efficacy, with mean differences of 0.046 (95% CrI: −1.1, 1.2) and 0.17 (95% CrI: −0.60, 0.93). For eGFR preservation, Telitacicept (0.739) (MD 8.1; 95% CrI −6.6, 22.0) and Mycophenolate (0.724) (MD 8.1; 95% CrI −7.3, 23.0) ranked highest, followed by Budesonide (0.712) (MD 6.5; 95% CrI −1.1, 15.0) and Atacicept (0.550) (MD 4.0; 95% CrI −7.0, 17.0). Hydroxychloroquine (0.436) (MD 2.4; 95% CrI −11.0, 16.0), Iptacopan (0.415) (MD 2.0; 95% CrI −12.0, 16.0), Placebo (0.250), and Fluticasone (0.175) (MD −2.8; 95% CrI −17.0, 11.0) demonstrated lower efficacy in preserving kidney function.

Conclusion

This systematic review and network meta-analysis indicate Mycophenolate and Telitacicept are most effective in reducing UPCR and improving eGFR, suggesting these as preferable treatments for IgAN patients.