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. 2021 Dec 15;15(5):895-902.
doi: 10.1093/ckj/sfab263. eCollection 2022 May.

Randomized clinical study to evaluate the effect of personalized therapy on patients with immunoglobulin A nephropathy

Francesco P Schena  1 , Giovanni Tripepi  2 , Michele Rossini  3 , Daniela I Abbrescia  4 , Carlo Manno  1
Affiliations

Randomized clinical study to evaluate the effect of personalized therapy on patients with immunoglobulin A nephropathy

Francesco P Schena et al. Clin Kidney J. .

Erratum in

Abstract

Background: Randomized controlled trials (RCTs) have been conducted, stratifying idiopathic immunoglobulin A nephropathy (IgAN) patients based on the laboratory findings [serum creatinine, estimated glomerular filtration rate (eGFR) and daily proteinuria]. In contrast, data from kidney biopsy have been used only for clinical diagnosis. Therefore, IgAN patients with active or chronic renal lesions have been receiving the same therapy in experimental and control arms of randomized clinical trials (RCTs).

Methods: Our clinical study of IgAN (CLIgAN) is a multicentre, prospective, controlled and open-label RCT based on patients' stratification at the time of their kidney biopsy. We will consider, first, the type of renal lesions, followed by serum creatinine values, eGFR and proteinuria. Primary and secondary endpoints will be monitored. Then, we will determine whether personalized therapy can slow the decline of renal function and delay end-stage kidney disease.

Results: We will enrol 132 IgAN patients with active renal lesions (66 patients per arm) in the first RCT (ACIgAN). They will receive corticosteroids combined with renin-angiotensin system blockers (RASBs) or only RASBs. A total of 294 IgAN patients with chronic or moderate renal lesions at high or very high risk of chronic kidney disease (147 patients per arm) will be enrolled in the second RCT (CHRONIgAN), in which they will receive dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, combined with RASBs, or RASBs alone.

Conclusion: Using this approach, we hypothesize that patients could receive personalized therapy based on renal lesions to ensure that the right drug gets to the right patient at the right time.

Keywords: corticosteroids; dapagliflozin; immunoglobulin A nephropathy; kidney biopsy; randomized controlled trial; renin–angiotensin system blockers.

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Figures

FIGURE 1:
FIGURE 1:
Schematic representation of the CLIgAN study. IgAN patients will be enrolled into two different RCTs. Patients with active renal lesions (E1 and/or C1) will be randomized to receive CS combined with RASBs versus RASBs alone. Patients with chronic (T1,2) or moderate (M0,1, S0,1, E0, C0, T0) renal lesions will be enrolled to receive SGLT2i (dapagliflozin) combined with RASBs versus RASBs alone. M, mesangial hypercellularity; E, endocapillary hypercellularity; S, segmental glomerulosclerosis; T, tubular atrophy/interstitial fibrosis; C, cellular or fibrocellular crescents; CS, corticosteroids; RASBs, renin–angiotensin system blockers; SGLT2i, sodium–glucose cotranspoter 2 inhibitor.
FIGURE 2:
FIGURE 2:
ACIgAN trial. Design of the study.
FIGURE 3:
FIGURE 3:
CHRONIgAN trial. Design of the study.
See this image and copyright information in PMC

References

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