Budesonide versus systemic corticosteroids in IgA Nephropathy

Abstract

IgA Nephropathy (IgAN) is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 molecules of gut-associated lymphoid tissue origin. We sought to evaluate the efficacy of targeting the mucosal immune system dysregulation underlying IgAN pathogenesis with a pH-modified formulation of budesonide with a maximum release of active compound in the distal ileum and proximal colon. We did a retrospective study evaluating the efficacy of budesonide (Budenofalk) in the treatment of IgAN. From a retrospective cohort of 143 patients with IgAN followed in our department we identified 21 patients that received treatment with budesonide. These patients received budesonide at a dose of 9 mg/d in the first 12 months, followed by a dose reduction to 3 mg/d for the subsequent period. Only patients that received a 24-month treatment with budesonide were included in the analysis (n = 18). We matched the budesonide-treated cohort to 18 patients with IgAN treated with systemic steroids from the same retrospective cohort. Efficacy was measured as change in proteinuria, hematuria and estimated glomerular filtration rate over a 24-month period. Treatment with budesonide was associated with a 24-month renal function decline of -0.22 (95%CI, -8.2 to 7.8) ml/min/1.73m2, compared to -5.89 (95%CI, -12.2 to 0.4) ml/min/1.73m2 in the corticosteroid treatment group (p = 0.44, for between group difference). The median reduction in proteinuria at 24-month was 45% (interquartile range [IQR]: -79%; -22%) in the budesonide group and 11% (IQR: -39%; 43%) in the corticosteroid group, respectively (P = .009, for between group difference). The median reduction in hematuria at 24-month was 72% (IQR: -90%; -45%) in the budesonide group and 73% (IQR: -85%; 18%) in the corticosteroid group, respectively (P = .22, for between group difference). Treatment with budesonide was well tolerated with minimal side effects. Budesonide (Budenofalk) was effective in the treatment of patients with IgAN at high-risk of progression in terms of reducing proteinuria, hematuria and preserving renal function over 24 months of therapy.

Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice

“…Targeted-release-formulation of budesonide (TRF-budesonide) has demonstrated promising results in terms of proteinuria and renal function in patients with immunoglobulin A nephropathy (IgAN) (1). Regarding its well tolerance, enteric budesonide may become the first step of immunosuppressive treatment of IgAN, although real world clinical practice publications are lacking (2)(3)(4). We evaluated the effect of budesonide in our cohort of patients affected by IgAN.…”

Effect of Montelukast sodium combined with Budesonide aerosol on airway function and T lymphocytes in asthmatic children

“… 12 At the same time, this kind of drug atomization inhalation can also prevent edema by contracting capillaries, inhibit the transfer of inflammatory cells to the site of inflammation attack, and thus prevent the occurrence or aggravation of airway inflammation in children. 13 Ismail G et al 14 showed that budesonide can effectively inhibit the redistribution of eosinophils and T lymphocytes in blood circulation, and plays an anti-inflammatory and immune function improvement role. Using budesonide by atomization inhalation can obtain more ideal lung absorption effect, improve drug concentration, ensure drug efficacy, reduce drug entry into blood circulation and reduce adverse drug reactions, especially for asthmatic children with relatively poor tolerance.…”

An Update on Targeted Treatment of IgA Nephropathy: An Autoimmune Perspective

“…This finding indicates a substantial systemic effect of TRF-budesonide and demonstrate that some amount of budesonide that is absorbed may act systemically rather than locally to attenuate albuminuria ( Glassock, 2017 ). Additionally, a retrospective, propensity-matched study evaluated the efficacy of budenofalk, a controlled-release formulation of budesonide, in 18 patients with IgAN in comparison with systemic corticosteroids ( Ismail et al, 2020 ). These results were consistent with the two aforementioned trials concerning albuminuria and renal function.…”