Abstract: TH-PO0535
Dual-Disease Management: Combining Biologic and Mucosal-Targeted Therapy in Ankylosing Spondylitis (AS) and IgAN
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
- Gao, Yi, Xi’an No.3 Hospital, Xi’an, China
Introduction
AS relies on NSAIDs, which risk nephrotoxicity and exacerbate IgAN, biologics (e.g., adalimumab) elevate infection risks. IgAN therapies (systemic steroids) endanger infection/bone health in AS on long-term biologics. Balancing efficacy and safety are paramount.
Case Description
A 44-year-old male with 10-year AS (adalimumab 40mg q2w) and abnormal urinalysis. In 2021, a biopsy confirmed IgAN (Lee II-III). Initial proteinuria 2.8g/d was reduced to 0.77g/d with aliskiren, dapagliflozin, finerenone, and hydroxychloroquine, but renal function deteriorated (eGFR from 112.44 to 83.15mL/min/1.73m2, Figure 1). In September 2024, Nefecon (16mg/d) was initiated. By March 2026, proteinuria fell to 0.39g/d, eGFR rose to 103.58mL/min/1.73m^2(Figure 1), and urine red cells decreased (Figure 2). Adalimumab continued throughout; no infections occurred, and AS remained stable.
Discussion
AS features gut dysbiosis, while IgAN pathogenesis centers on Gd-IgA1 overproduction in gut Peyer’s patches. This overlap explains comorbidity and treatment conflicts—adalimumab for AS lack clear IgAN benefit and may raise infection, while IgAN immunosuppressants risk infection in biologic-treated AS.
Nefecon circumvents these issues: it delivers high-dose budesonide to ileal Peyer’s patches. Here, Nefecon reversed renal decline and reduced proteinuria, despite prior conservative therapy having been unsatisfactory. Combining therapy caused no infections, and AS stayed controlled—addressing ‘superimposed immunosuppression’ concern.
Targeting IgAN’s mucosal origin (Nefecon) alongside systemic AS drug (adalimumab) offers a safe, effective strategy. Larger studies are needed to validate this management.