Kidney Week

Abstract: TH-PO0488

Dose-Dependent Efficacy and Safety of Atacicept in Patients with IgAN: A GRADE-Assessed Systematic Review and 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

• Chattha, Sarmad Elahi, King Edward Medical University, Lahore, Punjab, Pakistan

Sarmad Elahi Chattha, MBBS

• Jamshaid, Zainab, King Edward Medical University, Lahore, Punjab, Pakistan

Zainab Jamshaid, MBBS

• Kuraku, Dileep Raja, Vinnic'kij nacional'nij medicnij universitet imeni Mikoli Pirogova, Vinnytsia, Vinnytsia Oblast, Ukraine

Dileep Raja Kuraku, MD

• Shabih, Sumaiya, King Edward Medical University, Lahore, Punjab, Pakistan

Sumaiya Shabih, MBBS

• Talha, Muhammad, King Edward Medical University, Lahore, Punjab, Pakistan

Muhammad Talha

• Tanveer, Maryam, Bahria University Medical and Dental College, Karachi, Sindh, Pakistan

Maryam Tanveer, MBBS

• Asnani, Sunny, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan

Sunny Asnani, MD, MBBS

• Saad, Muhammad, King Edward Medical University, Lahore, Punjab, Pakistan

Muhammad Saad, MBBS

• Fatima, Maryam, King Edward Medical University, Lahore, Punjab, Pakistan

Maryam Fatima, MBBS

• Keshapogu, Nagarjuna, Vinnic'kij nacional'nij medicnij universitet imeni Mikoli Pirogova, Vinnytsia, Vinnytsia Oblast, Ukraine

Nagarjuna Keshapogu, MD

• Bhagavatula, Keertan Adarsh, Andhra Medical College, Visakhapatnam, AP, India

Keertan Adarsh Bhagavatula, MBBS

• Shah, Rajvi Mehulbhai, Narendra Modi Medical College, Ahmedabad, GJ, India

Rajvi Mehulbhai Shah, MBBS

• Nawaz, Balaj Sardar, King Edward Medical University, Lahore, Punjab, Pakistan

Balaj Sardar Nawaz, MBBS

• Amin, Fahad, King Edward Medical University, Lahore, Punjab, Pakistan

Fahad Amin, MBBS

Background

IgA nephropathy (IgAN), the most common primary glomerulonephritis, is frequently associated with progressive renal failure. Atacicept is an immunomodulating B-cell–targeted protein. This review is the first to evaluate the efficacy and safety of atacicept in IgAN.

Methods

Eligible studies were identified per PRISMA. Outcomes included changes in 24-hour urinary protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), galactose-deficient IgA1 (Gd-IgA1), hematuria, and adverse events (AEs). Data were analyzed with RevMan 5.4.1. using a random-effects model. Risk of bias was assessed with RoB 2.0 and evidence certainty with GRADE.

Results

Three studies (n = 361) comparing atacicept with placebo were included. At week 24, significant reductions in 24-hour UPCR were noted with high-dose (MD = –40.91%; 95% CI: –59.06 to –22.76%) and intermediate-dose atacicept (MD = –35.86%; 95% CI: –51.57 to –20.15%), whereas low-dose therapy showed no significant difference with similar trends at week 36. Improvement in eGFR at week 36 was significant only with intermediate dose (MD = 5.91 ml/min/1.73m2). Both high and intermediate doses significantly decreased Gd-IgA1 levels (MD = −63.60% & −44.92%). High-dose significantly reduced hematuria (MD = −60.30%). Regarding safety outcomes, high-dose was associated with fewer serious AEs (RR = 0.19) but more drug-related AEs (RR: 2.09), with no significant differences in discontinuation rates. Risk of bias was low in two studies, while one study raised some concerns.

Conclusion

Atacicept demonstrated significant, dose-dependent efficacy in IgAN. High and intermediate doses likely reduce 24-hour UPCR and Gd-IgA1 levels. The reduced hematuria with improved eGFR suggest a potential disease-modifying effect. The overall safety remains acceptable, although more drug-related AEs at higher dose. Findings are limited by fewer studies & short follow-up, necessitating larger RCTs with long-term data to confirm sustained clinical benefit.