{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:22:28Z","timestamp":1793110948674,"version":"4.5.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The targeted-release budesonide formulation (Nefecon) addresses IgA nephropathy (IgAN) by inhibiting mucosal immune dysregulation in gut-associated lymphoid tissue (GALT), leading to reduced production of galactose-deficient IgA1 (Gd-IgA1). Randomized controlled trials (NEFIGAN, NefIgArd) have shown that Nefecon effectively decreases proteinuria and decelerates the progression of chronic kidney disease (CKD) in patients with IgA nephropathy (IgAN). However, evidence in real-world clinical settings and high-risk subgroups remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study involving 60 IgAN patients treated with Nefecon (16 mg\/day) for no less than 6 months at the First Affiliated Hospital of Zhengzhou University between October 2024 and November 2025. The study focused on evaluating alterations in proteinuria and estimated glomerular filtration rate (eGFR). Subgroup analyses were further carried out according to the use of concomitant immunosuppressive therapy, baseline proteinuria levels, and baseline renal function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Proteinuria decreased significantly after 4 and 6 months of Nefecon treatment (median reduction 31.9% and 43.5%, respectively; both p &amp;lt; 0.001), while eGFR remained stable. Patients receiving Nefecon plus glucocorticoid\/immunosuppressive therapy achieved greater proteinuria reduction than those on Nefecon monotherapy (48.1%\n                      <jats:italic>vs<\/jats:italic>\n                      . 35.8% at 6 months, p=0.04). Notably, patients with a baseline eGFR &amp;lt; 35 mL\/min\/1.73 m\u00b2 showed a 38.9% reduction in proteinuria (p=0.002) without additional renal deterioration. Nefecon was well tolerated, with adverse events being mild.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In routine clinical practice, Nefecon effectively reduces proteinuria and preserves renal function in IgAN, even in patients excluded from randomized trials. The combination with immunosuppressive therapy may provide additive benefit that requires further validation. These findings extend trial results to real-world settings and highlight Nefecon as a practical treatment option for high-risk IgAN patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1761804","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:45:10Z","timestamp":1770273910000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Efficacy and safety of Nefecon in IgA nephropathy: real world clinical practice"],"prefix":"10.3389","volume":"17","author":[{"given":"Zihan","family":"Zhai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhibin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Gou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s00281-021-00884-7","article-title":"Is IgA nephropathy the same disease in different parts of the world? Seminars in Immunopathology","volume":"43","author":"Zhang","year":"2021","journal-title":"Seminars in Immunopathology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2023.12.016","article-title":"Time-varying proteinuria and progression of IgA nephropathy: A cohort study","volume":"84","author":"Tang","year":"2024","journal-title":"Am J Kidney Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000135","article-title":"Long-term outcomes in IgA nephropathy","volume":"18","author":"Pitcher","year":"2023","journal-title":"Clin J Am Soc Nephrol: CJASN"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.08.009","article-title":"Why target the gut to treat IgA nephropathy","volume":"5","author":"Barratt","year":"2020","journal-title":"Kidney Int Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30550-0","article-title":"Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial","volume":"389","author":"Fellstrom","year":"2017","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01554-4","article-title":"Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy (NefIgArd): 2-year results from a randomised phase 3 trial","volume":"402","author":"Lafayette","year":"2023","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0000000583","article-title":"Efficacy and safety of nefecon in patients with IgA nephropathy from Mainland China: 2-year NefIgArd trial results","volume":"5","author":"Zhang","year":"2024","journal-title":"Kidney360"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2025.04.003","article-title":"Executive summary of the KDIGO 2025 clinical practice guideline for the management of immunoglobulin A nephropathy (IgAN) and immunoglobulin A vasculitis (IgAV)","volume":"108","author":"Floege","year":"2025","journal-title":"Kidney Int"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.243","article-title":"The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification","volume":"76","author":"Cattran","year":"2009","journal-title":"Kidney Int"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1016\/j.kint.2017.02.003","article-title":"Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group","volume":"91","author":"Trimarchi","year":"2017","journal-title":"Kidney Int"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-017-3699-z","article-title":"New insights into the pathogenesis of IgA nephropathy","volume":"33","author":"Yeo","year":"2018","journal-title":"Pediatr Nephrol: J Int Pediatr Nephrol Assoc"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2024.12.007","article-title":"A targeted-release formulation of budesonide for the treatment of IgA nephropathy patients with severe renal impairment","volume":"10","author":"Ouyang","year":"2025","journal-title":"Kidney Int Rep"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1761804\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:45:11Z","timestamp":1770273911000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1761804\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2026.1761804"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1761804","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1761804"}}