Budesonide offers a safe and effective alternative to prednisone for treating immunoglobulin A nephropathy
Presenter: Abhi Lohana, MD, Camden Clark Medical Center, Parkersburg, West VA
In this study, budesonide was as effective as prednisone for treating patients with immunoglobulin A nephropathy and offers a more favorable safety profile.
For the long-term management of patients with immunoglobulin A nephropathy (IgAN) long term, budesonide is a superior alternative to prednisone, according to an analysis of patient data in the US Collaborative Network database. The analysis found a more favorable safety profile with lower rates of end stage renal disease (ESRD) and proteinuria for patients treated with budesonide versus prednisone, according to an abstract presented by lead author Abhi Lohana, MD, Camden Clark Medical Center, Parkersburg, WVA, in a Kidney Week 2024 oral presentation.
IgAN is one of the most common causes of chronic kidney disease worldwide, Dr. Lohana noted, adding that about 20% to 40% of patients with IgAN progress to ESRD. IgAN is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 antibodies originating from the intestinal mucosal lymphoid tissue. Current guidelines from the Kidney Disease: Improving Global Outcomes organization recommend steroids, including prednisone, for patients with persistent proteinuria despite optimal conservative care. Budesonide, a targeted steroid with a focus on the gut-associated lymphoid tissue, reduces the production of IgA1. It was introduced recently as an IgAN treatment, Dr. Lohana said.
In this study, investigators compared the efficacy of budesonide and prednisone for treating IgAN. Adult patients with IgAN were characterized and matched in two cohorts (n = 1,330 for prednisone; n = 1,332 for budesonide) based on propensity scores using current ICD terminology codes.
Although this comparative analysis showed mortality to be significantly lower in the prednisone cohort (4.3% vs 6.2%, risk difference minus 1.9%, P = .030), it also showed the incidence of ESRD to be significantly higher in the prednisone group (13.4% vs 5.0%, risk difference 8.3%, P < .001). Also, hematuria was significantly higher in the prednisone cohort (12.7% vs 9.6%, risk difference 3.1%, P = .038) as was proteinuria (35.0% vs 25.3%, risk difference 9.7%, P = .003). Incidence of microalbuminuria was similar in both groups (0.8% in each) as were rates of osteoporosis (2.8% vs 2.4%) and fungal infection (2.4% in both cohorts).
Dr. Lohana concluded, “This study reveals that while both prednisone and budesonide are effective in managing IgAN, budesonide offers a more favorable safety profile with significantly lower rates of ESRD and proteinuria. These findings support the use of budesonide as a viable and superior alternative to prednisone for the long-term management of IgA nephropathy.”