{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:41:48Z","timestamp":1792600908761,"version":"4.5.0"},"reference-count":29,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Nephrol"],"abstract":"<jats:p>Introduction: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of end-stage kidney disease. Targeted-release formulation (TRF) budesonide demonstrated significant reductions in proteinuria and attenuation of estimated glomerular filtration rate (eGFR) decline in the randomised NefIgArd trial. However, real-world effectiveness and tolerability in routine clinical practice remain less well characterised. We report real-world outcomes following initiation of TRF budesonide in a tertiary renal centre. Methods: We conducted a retrospective cohort study of all patients with biopsy-proven IgAN initiated on TRF budesonide between 1st January 2024 and 31st July 2025 at a single renal centre in the UK, with follow-up until 31st January 2026. Outcomes were changes in urine protein-to-creatinine ratio (UPCR) and eGFR from baseline to 3, 6, and 9 months and to the latest follow-up, assessed within patients using the Wilcoxon signed rank test. Intention-to-treat (ITT; all 33 patients commencing therapy) and per-protocol (PP; \u22656 months of therapy and not switched directly from modified-release budesonide) analyses were performed. Pre- and post-treatment eGFR slopes were compared using linear mixed-effects models, and a historical comparator cohort matched on baseline UPCR was drawn from the Salford Kidney Study; both are reported as exploratory. Results: Thirty-three patients commenced TRF budesonide, of whom 23 met PP criteria. Median age was 44 (IQR 37\u201360) years, baseline UPCR 212 (133\u2013289) mg\/mmol, and eGFR 48 (30\u201361) mL\/min\/1.73 m2. Renin-angiotensin system (RAS) inhibitor and sodium-glucose cotransporter-2 (SGLT2) inhibitor use were 94% and 91%, respectively. At the latest follow-up (median 11.2 months after treatment initiation), UPCR decreased by 60% (IQR 31\u201371%) in the ITT cohort (p &lt; 0.001) and 57% (IQR 26\u201372%) in the PP cohort (p &lt; 0.001). eGFR was stable across the treatment period, with no significant change from baseline at 9 months or at the latest follow-up in either analysis set. Pre- to post-treatment slope comparison was confounded by initiation of SGLT2 inhibitor therapy within the pre-treatment observation window and is reported as exploratory. An adverse effect was recorded in 9 of 33 patients (27%). Seven patients (21%) discontinued treatment, 6 for non-serious adverse effects and 1 for a serious adverse event (staphylococcal septicaemia requiring hospital admission); treatment was temporarily suspended in 1 further patient. Conclusion: In a real-world IgAN cohort with near-universal RAS and SGLT2 inhibitor use, TRF budesonide was associated with substantial proteinuria reduction, additive to optimised background therapy. eGFR was stable over the treatment period. Slope-based analyses could not be interpreted, because background SGLT2 inhibitor therapy was initiated within the pre-treatment observation window in nearly every patient. Discontinuation for adverse effects was more frequent than in trials, though symptoms were generally mild; adverse event frequencies are not directly comparable given retrospective ascertainment.<\/jats:p>","DOI":"10.1159\/ajn\/ablag015","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:12:42Z","timestamp":1789672362000},"page":"1-1","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Effectiveness of Targeted-Release Budesonide in IgA Nephropathy with Near-Universal SGLT2 Inhibitor Use"],"prefix":"10.1159","author":[{"given":"Thomas","family":"McDonnell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4764-8944","authenticated-orcid":false,"given":"William R.","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmilee","family":"Rengarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jude","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajkumar","family":"Chinnadurai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4117-4085","authenticated-orcid":false,"given":"Smeeta","family":"Sinha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip A.","family":"Kalra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1206793"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-022-03123-6"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2011050464"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0600"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30550-0"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.09.017"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01554-4"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204233"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-130-6-199903160-00002"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hct115"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2600743"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2512133"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2510198"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2514415"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415463"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.5368"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2025.04.004"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000135"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfag035"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-025-04991-4"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.168"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.243"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08600718"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.03.007"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S383138"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae394"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2012.197"}],"container-title":["American Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/ajn\/ablag015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:00:55Z","timestamp":1792598455000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/ajn\/ablag015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1159\/ajn\/ablag015","archive":["Portico"],"relation":{},"ISSN":["0250-8095","1421-9670"],"issn-type":[{"value":"0250-8095","type":"print"},{"value":"1421-9670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}