Targeted-release Budesonide (Nefecon) versus systemic glucocorticoids for IgA nephropathy: a placebo-anchored indirect treatment comparison of randomized controlled trials.

What was studied

This was an indirect comparison in IgA nephropathy (IgAN). It compared Nefecon with systemic glucocorticoids. Nefecon is a targeted-release budesonide. It pooled randomized trials of Nefecon 16 mg/day, systemic steroids or placebo. No trial compared the drugs head to head. The authors used placebo as the common link. The main outcome was yearly preservation of eGFR. Others were proteinuria and serious infections.

What they found

Nefecon's yearly eGFR gain over placebo was 2.95 mL/min/1.73 m2. Methylprednisolone improved it by 2.46. The indirect gap in eGFR was not significant. The mean difference was 0.49, with a range of -1.62 to 2.59. Proteinuria changed by -0.26 g/g per year with Nefecon. It changed by -0.69 with methylprednisolone. The indirect comparison favored methylprednisolone for proteinuria. The infection gap was not significant.

What it means for patients

The authors say both Nefecon and systemic steroids went with better kidney outcomes than placebo. They say the proteinuria and safety findings need care. They say head-to-head trials are needed.

Why it is not certain yet

This was an indirect comparison, not a head-to-head trial. The proteinuria analysis was exploratory. Measures and follow-up times had to be aligned. The infection range was very wide, at 0.04-7.16.

Source

Targeted-release Budesonide (Nefecon) versus systemic glucocorticoids for IgA nephropathy: a placebo-anchored indirect treatment comparison of randomized controlled trials.

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