#1984 Online education improved nephrologists’ knowledge of the immunopathogenesis of immunoglobulin A nephropathy and rationale for novel therapies

Abstract Background and Aims Globally, immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and the primary cause of chronic kidney disease and renal failure. IgAN has a heterogenous clinical presentation and prognosis and has a complex immunopathogenesis. Current management strategies focus on supportive care and the use of off label hypertensive drugs, angiotensin-converting enzyme (ACE) inhibitors and systemic glucocorticoids. As the treatment landscape evolves, there is a clear need for education on the immunopathogenesis of IgAN and the rationale for development of novel therapies. The goal of this activity was for learners to better understand the immunopathogenesis of IgAN and the mechanism of action (MOA) of emerging therapies. Method This online video activity was a 30-minute discussion between 2 expert faculty, with accompanying slides [1]. Responses to 3 pre- and post-assessment multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed. Educational effect was assessed using a repeated-pair design, pre-/post-assessment. A paired samples t-test was conducted for significance testing on overall average number of correct responses and for confidence rating. A series of McNemar's tests were conducted at the question level (5% significance level, P < .05). Cohen's d with correction for paired samples estimated the effect size of the education on number of correct responses (<.20 modest, .20–.49 small, .59–.79 moderate, ≥.80 large). The activity launched on 27 June 2024 with data collection through 5 September 2024. Results Of 1,427 nephrologists who viewed the education within this time period, 84 completed all pre- and post-assessment questions. The average percentage of correct responses increased significantly from 60% at baseline to 71% post-activity (P < .001), and there was a moderate educational impact (Cohen's d = 0.60). The proportion of nephrologists answering all 3 questions correctly rose from 23% at baseline to 37% post-activity. Nephrologists significantly improved their knowledge of the immunopathogenesis of IgAN (58% correct responses at baseline rising to 74% post-activity; P < .001), and the MOA of the emerging IgAN therapy iptacopan acting via the alternative complement pathways (73% vs 85% post-activity; P < .01). There was a numerical improvement in knowledge of the MOA of the APRIL (proliferation-inducing ligand) inhibitor sibeprenlimab acting via reduction of circulating levels of galactose-deficient IgA1 (Gd-IgA1) and associated immune complexes (48% vs 56% post-activity; P = .070). After completing the activity, 44% of nephrologists reported improved confidence in understanding of the mechanism of action of emerging treatments for IgAN, resulting in a notable confidence shift of 61%. Conclusion This online activity significantly improved nephrologists’ knowledge of the immunopathogenesis of IgAN and the rationale and MOA of some emerging therapies for IgAN. Given the rapidly evolving treatment landscape for IgAN, nephrologists would benefit from additional education to improve their knowledge of emerging therapies and translate this knowledge into clinical practice and improved patient outcomes.