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March 30, 2026Kidney International3 citationsOpen Access

Complement inhibitors and B-cell modifying agents for IgA nephropathy- a KDIGO commentary

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BRB.H. RovinJBJonathan BarrattHCH. Terence Cook

Key Points

  • This commentary aims to discuss the integration of new therapies for IgA nephropathy into existing treatment strategies.
  • Reviewed KDIGO guidelines for glomerular diseases during updates in 2021 and 2025.
  • Outlined the role of novel therapies approved for IgA nephropathy.
  • Provided insights on the therapeutic mechanisms of the newly approved drugs.
  • Three additional IgA nephropathy treatments received FDA accelerated approval after guideline updates.
  • New therapies differ mechanistically from previously approved options, indicating a shift in treatment strategies.

Abstract

Improving Global Outcomes (KDIGO) updated its Clinical Practice Guideline for Glomerular Diseases in 2021, more than a decade after the first glomerular diseases guideline came out, reflecting slow progress in drug development. But since that time, novel therapies for several glomerular diseases have been successfully tested and approved by regulatory agencies, none more so than IgA nephropathy (IgAN). To keep pace with new therapies, the IgAN guideline was updated again in 2025. After this revision came to press, 3 additional IgAN treatments received accelerated approval by the U.S. Food and Drug Administration (FDA). Because the presumptive mechanisms of action of 2 of these new therapies are mechanistically different than previously approved drugs, the KDIGO IgAN Work Group felt a brief commentary outlining where the new therapies may fit into the overall IgAN treatment strategy was warranted in lieu of a full guideline update pending additional evidence for these and other therapies.

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Rovin et al. (2026) studied this question.

synapsesocial.com/papers/69ca1280883daed6ee094e87https://doi.org/10.1016/j.kint.2026.03.003
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