Real-World Experience with Targeted-Release Budesonide in the Treatment of IgAN

Background: IgA nephropathy (IgAN) is the most common primary form of glomerulonephritis worldwide. Although the disease typically follows an indolent course, it remains a significant cause of progressive kidney disease and end-stage renal disease. Following the Kidney Health Initiative and the acceptance of proteinuria as a surrogate endpoint for clinical trials for glomerulonephritis, there has been a transformation in the management of IgAN. The NefIgArd trial resolved the decades-long question of the role of immunosuppression in the treatment of IgAN. The study led to the approval of targeted-release budesonide (Tarpyo), marking the introduction of the first disease-modifying therapy for IgAN. Herein, we present real-world data from our experience using Tarpeyo for IgA management. Methods: We report on 11 patients with primary IgAN treated with Tarpeyo (2023 and 2025). Results: Six patients (55%) were male (age 42.5±12.5 years). At the initiation of Tarpeyo, ten patients were receiving renin-angiotensin-aldosterone system (RAAS) inhibitors, including three patients on sparsentan. Six patients (55%) were on SGLT2 inhibitors (Figure 1). The mean pretreatment UPCR was 2,100 mg/g. After treatment, the mean UPCR was 990 mg/g, a 52% reduction. The mean serum creatinine before treatment was stable at 1.25 mg/dL (Figure 2). Treatment was well tolerated. Each of these side effects was observed in one patient: worsening glycemic control, worsening hypertension, acne, and peripheral edema. One patient discontinued treatment early due to adverse events (facial edema and abdominal striae). No serious infections were reported during the treatment period. Conclusion: At our center, Tarpeyo produced outcomes comparable to those observed in the Phase III NefIgArd trial, with a significant reduction in proteinuria and an acceptable safety and tolerability profile.