In Advocacy Strategies and the Expanding Role of Novel Therapies in IgA Nephropathy

What are your impressions of novel therapies like sparsentan, nefecon, iptacopan, atrasentan, sibeprenlimab, and BAFF/APRIL inhibitors, and how do you see their role evolving in IgAN treatment?

Led by the Dr. Edward Skolnik, Dr. Swati Arora discusses how clinicians can improve access to IgA nephropathy therapies by proactively documenting disease severity, prior supportive care optimization, and steroid contraindications within prior authorization submissions to preempt step-edit denials. Multidisciplinary collaboration—particularly with pharmacists—can streamline appeals, provide literature support, and track payer-specific requirements to reduce delays. Leveraging real-world evidence from registries such as RaDaR can strengthen the clinical rationale for targeted therapies by demonstrating longitudinal reductions in proteinuria and slower eGFR decline outside of clinical trials, thereby increasing payer confidence. As outcomes data mature, these registries may help shift policies away from mandatory steroid exposure toward risk-stratified, mechanism-based treatment pathways. Novel agents—including sparsentan, nefecon, iptacopan, atrasentan, sibeprenlimab, and emerging BAFF/APRIL inhibitors—are reshaping IgAN management by targeting distinct pathogenic pathways such as complement activation, endothelin signaling, and B-cell–mediated immune dysregulation. Their roles will likely evolve toward earlier use in patients with persistent proteinuria despite optimized supportive care, those at high risk for progression, or individuals with contraindications to systemic steroids.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, Rethinking KDIGO Guidance and Payer Models in the Era of Targeted IgA Nephropathy Therapies, further explores IgA nephropathy clinical insights.