Disease-Targeted Therapies and eGFR Slope over 2 Years in IgA Nephropathy: A Systematic Review and Network Meta-Analysis

In phase 3 placebo-controlled trials of IgA nephropathy, telitacicept reduced annualized total eGFR slope decline by a between-group difference of 5.1 ml/min per 1.73 m2 per year over at least 96 weeks.

• Why it matters: Direct head-to-head comparisons among disease-targeted therapies for IgA nephropathy are limited, despite reported 2-year eGFR slope effects, leaving uncertainty about which mechanisms perform best.
• What they did: A frequentist network meta-analysis pooled six placebo-controlled randomized trials (2437 participants) from PubMed, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and nephrology abstracts, using annualized total eGFR slope over at least 96 weeks.
• The result: Across indirect comparisons, APRIL or BAFF/APRIL–targeting agents showed a pooled between-group difference of 4.8 (4.2 to 5.5) and a pooled relative reduction of 98% (82% to 113%) versus 34% to 49% for other agents, with safety signals varying by drug.

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