Abstract: TH-PO0528
Real-World Experience of Sequential Targeted-Release Formulation (TRF)-Budesonide and Sparsentan Therapy in Patients with IgAN: A Case Series
Session Information
- Glomerular Diseases: IgAN, IgA Vasculitis, and More
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
Author
- Zheng, Sijie, The Permanente Medical Group Inc, Oakland, California, United States
Introduction
Multiple FDA-approved therapies for IgA nephropathy (IgAN) have emerged in recent years. However, the optimal therapeutic sequencing for individual patients remains challenging. We present a case series of three patients with IgAN and persistent proteinuria despite maximal supportive care, all of whom were initially treated with TRF-budesonide without adequate response or with side effects and were subsequently transitioned to Sparsentan with successes.
Case Description
Case 1: A 50 y.o. male with IgAN in 2013,. He was treated with dual RAAS blockade for many years, with a UPCR remained at 2.4–3.0 g/g in 2021. Empagliflozin was initiated in July 2021 with an initial UPCR decrease to 0.9 g/g, which subsequently rebounded to the 2.0 g/g. TRF-budesonide was started; however, UPCR remained at 2.5–3.0 g/g, thus TRF-budesonide was tapered off after 9 months. Sparsentan was initiated, with UPCR decreasing to 1.1 g/g within one month, and further declined to 0.4 g/g
Case 2: A 40 y.o. male with IgA vasculitis (IgAV) and IgAN was initially treated with prednisone and achieved remission. Proteinuria subsequently relapsed with UPCR of 1.5 after prednisone taper, and TRF-budesonide was initiated. The patient did not tolerate it due to steroid-related side effects, including weight gain. After discontinuation, Sparsentan started, achieving a UPCR of 0.2 g/g.
Case 3: A 50 y.o. female with IgAN and a UPCR of 4.0 g/g was started on TRF-budesonide but developed facial swelling, necessitating discontinuation. The patient was switched to Sparsentan, with UPCR decreased to 2.0 g/g. However, the patient subsequently developed arm numbness and arm pain, and Sparsentan had to be discontinued, her pain subsided after the discontinuation of Sparsentan.
Discussion
This case series illustrates the real-world challenges of sequential therapy in IgAN, Sparsentan produced substantial proteinuria reduction in three patients after inadequate response or intolerance to TRF-budesonide, while one patient required discontinuation due to adverse effects. The rapid expansion of approved therapies for IgA nephropathy has shifted the clinical challenge toward identifying the right treatment for each patient. This case series offers valuable real-world insight into variability in response and tolerability, supporting more informed and individualized therapeutic approach.