TOPLINE

In patients with immunoglobulin A (IgA) nephropathy already receiving optimised therapy, including SGLT2 inhibitors, treatment with sparsentan was associated with a rapid reduction in proteinuria at 3 months that was maintained for up to 12 months; kidney function remained stable throughout follow-up, and the safety profile was favourable.

METHODOLOGY

• Researchers conducted a real-world retrospective study across 14 Spanish centres to evaluate the early antiproteinuric response to sparsentan and assess its medium-term efficacy and safety in patients with IgA nephropathy treated according to current standards of care.
• They included 41 patients with biopsy-proven IgA nephropathy (median age, 42 years; 39% women), all of whom completed at least 3 months of follow-up; 33 patients had follow-up data at 6 months and 23 had follow-up data at 12 months.
• All patients had received optimised renin-angiotensin system blockade at the maximum tolerated dose before the initiation of sparsentan, and 95% were receiving SGLT2 inhibitors at baseline; 16 patients were receiving concomitant immunosuppressive therapy at the time of sparsentan initiation.
• The primary outcome was the achievement of a greater than 50% reduction in proteinuria among patients at 3 months after the initiation of sparsentan.
• Secondary outcomes included changes in proteinuria at 6 and 12 months; evolution of kidney function over time; changes in blood pressure; and safety outcomes including hyperkalaemia, acute kidney injury, and liver enzyme abnormalities.

TAKEAWAY

• Median proteinuria decreased significantly from 1163 mg/24 h at baseline to 772 mg/24 h at 3 months (P < .01), representing a median relative reduction of 44.1%, with 51% of patients achieving a reduction of greater than 50% in proteinuria.
• Among patients with extended follow-up, the antiproteinuric effect was sustained, with a median reduction of 46.9% at 6 months. At 12 months, the median reduction remained substantial at 38.9%, although greater variability was observed in this smaller subgroup.
• Kidney function remained stable during the 12-month follow-up period, with no change in the median estimated glomerular filtration rate from baseline.
• No clinically significant hyperkalaemia was observed; mild, transient hyperkalaemia occurred in four patients. Five episodes of acute kidney injury were reported, all of which were resolved without the need for renal replacement therapy.

IN PRACTICE

"In a real-world population characterized by prior optimization of therapy and widespread use of SGLT2 inhibitors, the magnitude and persistence of proteinuria reduction, together with stable kidney function, support the role of sparsentan as a meaningful therapeutic option in IgAN [IgA nephropathy]," the authors wrote.

SOURCE

This study was led by Clara García-Carro, San Carlos Clinical University Hospital, National Reference Centre for Complex Glomerular Diseases, Madrid, Spain. It was published online on September 01, 2026, in Clinical Kidney Journal.

LIMITATIONS

The study was retrospective and had a relatively small sample size. The assessment of haematuria was not standardised across centres. In addition, the absence of a control group limited the ability to attribute observed outcomes solely to sparsentan rather than to concomitant background therapies.

DISCLOSURES

This study did not report any specific funding. Some authors disclosed receiving research grants, travel grants, personal fees, honoraria, or congress support; serving as members of editorial or advisory boards; or holding other ties with various pharmaceutical companies or organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.