Abstract: SA-PO0657
COMBO-IGNITE: Real-World Effectiveness and Early Safety Signals of Combination Therapy for IgAN
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
October 24, 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
- Vasquez-Rios, George, Renal Medicine Associates, Albuquerque, New Mexico, United States
- Rajasekaran, Arun, Renal Medicine Associates, Albuquerque, New Mexico, United States
- Hussain, Muzammil, Renal Medicine Associates, Albuquerque, New Mexico, United States
- Kumar, Jayant, Renal Medicine Associates, Albuquerque, New Mexico, United States
- Larranaga, Jorge A., Central Florida Kidney Specialists, Orlando, Florida, United States
- Madan, Arvind, Central Florida Kidney Specialists, Orlando, Florida, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Campbell, Kirk N., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Sanchez Russo, Luis F., Central Florida Kidney Specialists, Orlando, Florida, United States
Background
Therapeutic advances in IgA nephropathy (IgAN), including dual endothelin-angiotensin receptor antagonists (DEARAs) and targeted-release budesonide (TRB), have improved proteinuria reduction and kidney outcomes. However, real-world evidence evaluating combination therapy remains limited. We assessed early effectiveness and safety signals of combination therapy versus monotherapy in a multicenter IgAN cohort.
Methods
We conducted a retrospective cohort study of adults with biopsy-proven IgAN and baseline UACR >0.3 g/g. Combination therapy was defined as initiation of DEARA and TRB within 30 days; monotherapy was defined as DEARA alone. The primary endpoint was percent change in UACR at 24 weeks using geometric mean change from baseline. Secondary endpoints included ≥30% and ≥50% UACR reduction, achievement of UACR <0.2 g/g, and change in eGFR.
Results
Nine patients were included (combination n=4; monotherapy n=5). Mean age was 44.3±14.3 years, 55.6% were male, and 44.4% were non-White. Combination-treated patients had more advanced disease at baseline, with lower eGFR (33.8±10.5 vs 77.6±18.9 mL/min/1.73m2) and higher UACR (2.9±1.4 vs 1.0±0.2 g/g). At 24 weeks, the overall cohort demonstrated a reduction in the geometric mean of UACR of 41.3%. Among combination-treated patients, 50% achieved ≥30% UACR reduction and 25% achieved ≥50% reduction. In the monotherapy group, 100% and 80% achieved these thresholds, respectively. Median ΔeGFR at 24 weeks was +13.5 mL/min/1.73m2 (IQR -3 to +14) in the combination group versus 0 (IQR -2 to 0) in the monotherapy group. No major early safety signals were identified. There are several limitations including selection bias and confounded by indication.
Conclusion
In this real-world IgAN cohort, combination therapy of DEARA and TRB was used in patients with more advanced disease yet demonstrated encouraging early kidney function stabilization/improvement and proteinuria reduction. Larger prospective studies are needed to evaluate the efficacy and safety of combination therapeutic strategies in high-risk IgAN populations.