Kidney Week

Abstract: SA-PO0645

Efficacy of Sparsentan in FSGS: A Meta-Analysis of Randomized Clinical Trials

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

• Ahmed, Zahoor, Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, United States

Zahoor Ahmed, MD

• Chewaproug, Daranee, Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, United States

Daranee Chewaproug, DO, FASN

• Nasir, Hira, King Edward Medical University, Lahore, Punjab, Pakistan

Hira Nasir, MBBS

• Gupta, Astha, Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, United States

Astha Gupta, MD

• Shin, Ji Young, Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, United States

Ji Young Shin, MD

• Mubin, Fareeha, Jefferson Einstein Philadelphia Hospital, Philadelphia, Pennsylvania, United States

Fareeha Mubin, MD

Background

Despite conventional renin-angiotensin-aldosterone system blockade, many patients with focal segmental glomerular sclerosis (FSGS) continue to experience disease progression. Sparsentan, a dual endothelin type A and angiotensin II type 1 receptor antagonist was recently approved for FSGS. This study aims to analyze efficacy of sparsentan in FSGS patients.

Methods

We conducted a systemic literature search using PubMed, EMBASE and Google scholar from date of inception to April 2026. Initial search yielded 109 articles. We included two randomized clinical trials (RCT), reporting efficacy of sparsentan in FSGS. Risk ratios (RR) for proteinuria reduction were calculated using RStudio v4.4.3. Pooled RRs, 95% confidence intervals (CIs), and p-values were estimated using a random-effects model. Blood pressure (BP) and eGFR changes were analyzed using reported mean differences.

Results

Our analysis included two RCTs involving 480 patients with biopsy-proven FSGS. DUET (RCT-II) compared sparsentan (n=73) with irbesartan (n=36) over 8 weeks, while DUPLEX (RCT-III) evaluated sparsentan (n=184) vs irbesartan (n=187) over 12 weeks.
Pooled analysis demonstrated significantly higher rates of both partial remission (RR 1.77, 95%CI 1.22–2.58; p<0.05) and complete remission (RR 2.67, 95%CI 1.34–5.30; p<0.05) of proteinuria in sparsentan group vs irbesartan group (Figure). At week 8, sparsentan was also associated with greater reductions in systolic (mean difference −7.2 mmHg; p=0.002) and diastolic (mean difference −5.6 mmHg; p=0.001) BP. Early eGFR decline was numerically greater with sparsentan, with no statistically significant (mean difference −4.2 mL/min/1.73 m²; p=0.28).

Conclusion

Sparsentan showed promising efficacy in FSGS patients, with greater reductions in proteinuria and BP compared with irbesartan, with acceptable safety profile, providing a benchmark for future studies.