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Improving outcomes in glomerular disease

Glucocorticoid exposure remains a major contributor to morbidity and mortality in patients with immune-mediated kidney disease. Recent clinical trials have tested novel potential therapies for these patients and showed that glucocorticoid doses can be reduced without compromising efficacy.

Key advances

  • C5a receptor antagonism with avacopan is effective in combination with cyclophosphamide or rituximab for inducing and maintaining remission in severe anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and reduces glucocorticoid requirements.

  • Reducing glucocorticoid dose with rituximab for the induction of remission in AAV does not compromise short-term efficacy and reduces serious infections.

  • Use of the calcineurin inhibitor voclosporin with mycophenolate mofetil (MMF) and glucocorticoids improves renal response in patients with class III–V lupus nephritis and eGFR >45 ml/min/1.73 m2.

  • Obinutuzumab combined with MMF and glucocorticoids increases renal response in patients with class III–IV lupus nephitis.

  • Inhibition of sodium–glucose co-transporter 2 with dapagliflozin in proteinuric IgA nephropathy improves renal outcomes.

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  1. Jayne, D. R. W., Merkel, P. A., Schall, T. J. & Bekker, P. Avacopan for the treatment of ANCA-associated vasculitis. N. Engl. J. Med. 384, 599–609 (2021).

    CAS  Article  Google Scholar 

  2. Walsh, M. et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N. Engl. J. Med. 382, 622–631 (2020).

    CAS  Article  Google Scholar 

  3. Furuta, S. et al. Effect of reduced-dose vs high-dose glucocorticoids added to rituximab on remission induction in ANCA-associated vasculitis: a randomized clinical trial. J. Am. Med. Assoc. 325, 2178–2187 (2021).

    CAS  Article  Google Scholar 

  4. Rovin, B. H. et al. Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 397, 2070–2080 (2021).

    CAS  Article  Google Scholar 

  5. Furie, R. A. et al. B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial. Ann. Rheum. Dis. (2021).

    Article  PubMed  Google Scholar 

  6. Rauen, T. et al. Intensive supportive care plus immunosuppression in IgA nephropathy. N. Engl. J. Med. 373, 2225–2236 (2015).

    CAS  Article  Google Scholar 

  7. Lv, J. et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. J. Am. Med. Assoc. 318, 432–442 (2017).

    CAS  Article  Google Scholar 

  8. Wheeler, D. C. et al. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy. Kidney Int. 100, 215–224 (2021).

    CAS  Article  Google Scholar 

  9. Barratt, J. & Floege, J. SGLT-2 inhibition in IgA nephropathy: the new standard of care? Kidney Int. 100, 24–26 (2021).

    CAS  Article  Google Scholar 

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Correspondence to Rachel B. Jones.

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Competing interests

A.K. has received consultancy fees from Vifor Pharma, Alexion, Otsuka and Catalyst Biosciences. R.B.J. has received grants from GSK and Roche, and has consulted for Chemocentryx, Vifor Pharma and GSK.

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Kronbichler, A., Jones, R.B. Improving outcomes in glomerular disease. Nat Rev Nephrol 18, 82–83 (2022).

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