In the discussion between Jonathan Barratt, PhD, FRCP, and Brad Rovin, MD, they explore the challenges and potential therapeutic approaches for IgA nephropathy (IgAN). Dr Rovin begins by acknowledging the limitations of current treatments that primarily address the consequences of kidney damage rather than the underlying causes. He emphasizes the need for foundational therapies that intervene at the level of kidney damage. However, he cautions that this alone is not sufficient, as it doesn't address ongoing aberrant IgA accumulation and inflammation in the kidney, the primary processes driving IgAN.

Dr Rovin suggests a shift in focus towards developing drugs that inhibit the disease's pathogenesis itself. He expresses the desire for a drug that targets the production of galactose-deficient IgA, which is considered the instigating immunoglobulin in IgAN. By interrupting or reducing the production of this pathogenic molecule, the goal is to control local kidney damage. Dr Rovin envisions a multi-step approach: foundational therapies to control proteinuria, drugs inhibiting disease pathogenesis, and addressing inflammation induced by IgA deposition.

The conversation delves into the importance of histological evaluation of kidney biopsies to guide therapeutic decisions. Dr Rovin emphasizes the need for an anti-inflammatory component, especially in cases where the kidney biopsy reveals significant inflammation. However, he acknowledges the challenge of adding multiple drugs to the treatment regimen, considering the potential side effects, and the need for a targeted, less systemically impactful approach.

The discussion touches on the historical use of systemic glucocorticoids in IgAN and the varying trial results regarding their efficacy. Dr Rovin expresses optimism about the evolving therapeutic landscape, envisioning drugs that specifically target kidney inflammation with fewer systemic side effects. He emphasizes the importance of identifying markers indicating controlled inflammation, allowing for tailored treatment strategies.

Overall, the conversation outlines a comprehensive and nuanced approach to IgAN treatment, emphasizing the need for therapies that address the root causes of the disease rather than merely alleviating symptoms.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.