Abstract: TH-PO0475
Complement Inhibition in IgAN: A Systematic Review and Meta-Analysis of Clinical Trials
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - IgAN
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Shen, Xue, Peking University First Hospital, Beijing, China
- Zhang, Hong, Peking University First Hospital, Beijing, China
- Lv, Jicheng, Peking University First Hospital, Beijing, China
Background
Substantial progress has been made in complement-targeted therapies for IgA nephropathy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of complement inhibitors targeting the alternative and terminal pathways in patients with IgA nephropathy.
Methods
We systematically searched PubMed, Embase, Cochrane Library, and Web of Science, from inception to March 10, 2026, supplemented by manual searches of conference proceedings and ClinicalTrials.gov. Treatment effects on proteinuria and estimated glomerular filtration rate (eGFR), as well as safety outcomes, were pooled using random-effects models for randomized controlled trials (RCTs). Subgroup analyses were conducted according to complement pathway targets.
Results
A total of 7 randomized controlled trials involving 568 patients were included. Complement inhibition was associated with significant reductions in proteinuria at 6–9 months (placebo-adjusted change: -36.0%, 95% CI -43.5% to -28.5%; Figure 1) and a favorable effect on eGFR slope compared with placebo (mean difference: 3.1 mL/min/1.73 m2/year, 95% CI 2.1 to 4.1; Figure 2). Subgroup analyses by complement pathway showed comparable proteinuria reductions between alternative pathway–targeted agents (−37.2%) and terminal pathway–targeted agents (−31.7%), with no significant subgroup difference. Complement inhibitors were generally well tolerated, with no significant increase in serious adverse events compared with placebo (RR = 1.42, 95% CI 0.75 to 2.68).
Conclusion
Complement inhibition was associated with clinically meaningful reductions in proteinuria and favorable effects on eGFR in patients with IgA nephropathy, with generally acceptable safety profiles. Longer-term, adequately powered studies are needed to confirm durability of benefit and clarify the role of complement-targeted therapy in IgA nephropathy.
Figure 1. Effect of complement inhibitors on proteinuria in IgA nephropathy.
Figure 2. Effect of complement inhibitors on annualized eGFR slope in IgA nephropathy.