Neurologists are using recently approved drugs to treat patients with immunoglobulin A neuropathy but see an unmet need for more innovation: Survey
Presenter: Justin Snyder, MD, Spherix Global Insights, Exton, PA.
Nephrologists continue to see an unmet need for new drugs that effectively treat the root cause of immunoglobulin A neuropathy and that further enable practitioners to individualize treatments.
Most nephrologists treating patients with immunoglobulin A neuropathy (IgAN) have adapted the newest therapies into their clinical practice, but they also see a need for more therapeutic innovations for this disease state, according to data from an online survey abstract presented by Justin Snyder, MD, Spherix Global Insights, Exton, PA, during a Kidney Week 2024 oral presentation.
With the accelerated Food and Drug Administration approval of delayed-release oral budesonide and sparsentan for IgAN, most nephrologists (80%) indicated that they felt better equipped to treat their patients with IgAN, according to this analysis by Dr. Snyder and colleagues. They used data collected via online surveys from 454 audited patient charts collected in partnership with 142 US nephrologists in January 2024 and in partnership with an additional 105 US nephrologists in February 2024.
The analyses also showed that 72% and 66% of nephrologists are using budesonide or sparsentan, respectively, as third-line (or later) treatments following administration of renin angiotensin-aldosterone system inhibitors and sodium-glucose transport protein 2 inhibitors. Despite that high use level, nearly half of nephrologists (46%) remain unconvinced that existing therapies alone can achieve the desired proteinuria goals, creating a need for new pharmaceuticals focused on targeting the root cause of IgAN, Dr. Snyder noted.
Results also showed that although the theoretical main source of the galactose-deficient IgA1 antibodies that cause damage and inflammation to the kidneys is the Peyer’s patches (lymphoid tissues located in the wall of the small intestine that play a crucial role in immune defense), nearly one-half of nephrologists surveyed are unconvinced that targeting the Peyer’s patch is an important goal in treatment. On the other hand, 68% of nephrologists agree that IgAN is a B cell mediated disease, in which the root cause of galactose-deficient IgA1 production comes from overstimulated B cells and plasma cells. Additionally, 76% believe that the complement system plays an active role in the pathogenicity of IgAN.
Nephrologists, Dr. Snyder said, indicated they would be at least somewhat likely to prescribe drugs that targeted these pathways. Two such agents being investigated are iptacopan, a complement factor B inhibitor, and atacicept, which is both a B lymphocyte stimulator inhibitor and a proliferation-inducing ligand inhibitor that targets B cells and plasma cells.
“What the survey showed clearly,” Dr. Snyder concluded, “is that nephrologists continue to see an unmet need in the IgAN space, that there is room for new market entrants that effectively treat the root cause of the disease and that further enable physicians to individualize treatments.”