Mapping the complement-targeted landscape in igA nephropathy: a systematic review with structured descriptive synthesis.

What was studied

This review updated data on complement-blocking drugs for IgA nephropathy. Late-stage data have lately come out. They include 24-month APPLAUSE-IgAN results. The team searched up to April 24, 2026. Trials had to test these drugs in adults. Adults had biopsy-proven disease. The drugs act on different targets. So results were not pooled.

What they found

The review had 584 people from randomized trials. They covered factor B and C5 blocking. The late-stage iptacopan trial showed less protein in urine. It also showed slower loss of kidney function. It showed a lower risk of kidney failure. But it showed more serious infections. These included confirmed pneumococcal infections. Mid-stage trials gave early signs of benefit.

What it means for patients

The authors say signals differ across trials. They say differences in targets, design and entry rules rule out a uniform class effect. They call for late-stage programmes built around each mechanism.

Why it is not certain yet

Mid-stage trials reported no encapsulated-bacterial events. Small size and short follow-up limit safety conclusions. Methods differed across trials. The differences were mainly in biopsy timing and fibrosis exclusion. The authors call the findings hypothesis-generating.

Source

Mapping the complement-targeted landscape in igA nephropathy: a systematic review with structured descriptive synthesis.

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