Abstract: TH-PO0455
Comparative Efficacy and Safety of IgAN Treatments: A Bayesian Network Meta-Analysis
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
- Mechery, Vinodh, University of Miami Health System, Miami, Florida, United States
- Contreras, Gabriel, University of Miami Health System, Miami, Florida, United States
- Kota, Sanjana, University of Miami Health System, Miami, Florida, United States
Background
Treatments for IgA nephropathy (IgAN) have expanded rapidly across novel pathways including APRIL/BAFF, complement factor B, endothelin receptors, and mucosal immunity. Absence of head-to-head trials complicates clinical decision-making. We used Bayesian network meta-analysis to generate pairwise comparative estimates across efficacy and safety outcomes.
Methods
We searched PubMed, Embase, and Cochrane Library for RCTs treating IgAN with >30 participants per arm and ≥12 weeks RAASi optimization. A fixed-effects Bayesian NMA compared percentage reduction in 24-hour UPCR/UPER and annualized eGFR slope (ml/min/1.73m2/yr), reported as pairwise mean differences (95% credible intervals). Serious adverse events (SAEs) and infectious events (IEs) were modelled using a binomial complementary log-log model with per-person follow-up offset, yielding pairwise hazard ratios.
Results
Eleven RCTs (n=3,298) with ten treatments and protocols were included: Sibeprenlimab, Atacicept, Iptacopan, Mycophenolate mofetil, Budesonide, STOP-IgAN, Methylprednisolone, Sparsentan, Atrasentan, and standard of care (SOC). SUCRA analysis ranked Sibeprenlimab highest for proteinuria reduction, and Atacicept (150mg) and Sibeprenlimab (8mg/kg) as co-leaders for eGFR preservation. Atacicept was the only agent with significantly lower SAE versus SOC [HR 0.18 (95% CI: 0.04–0.58)]. No treatment differed significantly from SOC for IEs.
Conclusion
Sibeprenlimab ranked highest for proteinuria reduction and co-ranked with Atacicept for eGFR preservation; Atacicept was the only agent with significantly lower SAE hazard versus all treatments. No treatment differed significantly from SOC for IEs. These findings highlight the need for direct head-to-head RCTs to confirm the comparative efficacy and safety profiles suggested by indirect network estimates.
Acknowledgment
League table pdfs were generated with assitance from Claude (Anthropic, San Francisco, Ca, USA)