Abstract: FR-PO0849
Real-World Treatment for IgAN in the Veterans Health Administration
Session Information
- Glomerular Outcomes: From Proteinuria to Prognosis
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States
- Madison, Terri, Calliditas Therapeutics AB, Stockholm, Stockholm County, Sweden
- Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States
- Ngai, Christopher, Calliditas Therapeutics AB, Stockholm, Stockholm County, Sweden
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background
Real world data about use and discontinuation of existing and novel therapies for IgA nephropathy (IgAN) are limited. We examined this in a national integrated health system.
Methods
Using data from the Veterans Health Administration from 2015 to 2024, we identified people with incident CKD stages 3-4, defined as two eGFR values <60 mL/min/1.73 m2 ≥90 days apart. Incident IgAN was identified using diagnosis codes, excluding individuals who had any past code for IgAN. We excluded those with ESKD, active malignancy, lupus, transplant, hepatitis B, C, or D, HIV, Henoch Schönlein purpura, ankylosing spondylitis, or dermatitis herpetiformis. IgAN treatments, including systemic glucocorticoids (SGC), other immunosuppressants (azathioprine, mycophenolate, or cyclophosphamide), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), sodium-glucose co-transporter 2 inhibitors (SGLT2i), and novel treatments (iptacopan, sparsentan, targeted delayed-release budesonide) were ascertained using pharmacy records and categorized as continued use at IgAN diagnosis, incident use at IgAN diagnosis, discontinued use after IgAN diagnosis, or no use.
Results
Of 1803 veterans included in the cohort, most were older, with 1450 (80%) age 60 or older, and 440 (24%) were on an ACEi/ARB within 90 days prior to IgAN diagnosis. Most (57%) were treated with SGC, and 11% were treated with other immunosuppressants, implying the presence of clinically significant proteinuria as part of assessing high risk as an indication for immunosuppression (Figure). Despite this, after IgAN diagnosis only 507 (28%) received an ACEi, 358 (20%) received an ARB, and 345 (19%) received an SGLT2i (Figure). Novel IgAN-directed treatments were received by too few individuals to report.
Conclusion
Low rates of existing and novel treatment use in this cohort reveal an opportunity to improve adherence to draft updates to IgAN guidelines that suggest using immunomodulating agents concurrently with supportive therapies such as ACEi/ARBs and SGLT2is. Many people discontinued treatments, suggesting a possible role for novel therapies as alternative options.
Funding
- Commercial Support – Calliditas NA Enterprises Inc