{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:43:29Z","timestamp":1788885809771,"version":"build-2803163510"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"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>Background<\/jats:title>\n                    <jats:p>Targeted-release budesonide (Nefecon) has demonstrated efficacy in randomized trials for IgA nephropathy (IgAN), yet direct comparative real-world evidence against systemic corticosteroids is scarce, limiting clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a longitudinal real-world study of adult patients with biopsy-proven IgAN treated with either Nefecon or systemic corticosteroids. Renal outcomes, including estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), 24-hour urinary protein excretion (24hUP), and urinary red blood cell count (URBC), were assessed at baseline and at 3, 6, and 9 months. Longitudinal associations were evaluated using linear mixed-effects models adjusted for age, sex, systolic and diastolic blood pressure, with multiple imputation for missing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 82 patients were included (Nefecon, n=32; systemic corticosteroids, n=50). Both treatments were associated with significant reductions in proteinuria-related outcomes over time. Compared with systemic corticosteroids, Nefecon showed a trend toward greater early reduction in UACR at 3 months after expanded adjustment and an adjusted exploratory short-term favorable difference in eGFR at 6 months. However, this eGFR difference was not sustained at 9 months, and the primary outcome (24hUP) showed no significant between-group difference at any time point.Severe infections and steroid-related adverse events were numerically less frequent in the Nefecon group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In routine clinical practice, Nefecon showed antiproteinuric efficacy comparable to systemic corticosteroids, with no significant difference in the primary outcome (24hUP) between groups. An exploratory short-term favorable eGFR signal was observed at 6 months, but this was not sustained at 9 months and should not be interpreted as evidence of sustained renal protection. Severe infections and steroid-related adverse events were numerically less frequent in the Nefecon group, but limited event counts warrant cautious interpretation. Longer follow-up is required to determine whether these exploratory findings are clinically meaningful.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1831633","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:03:30Z","timestamp":1785305010000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Targeted-release budesonide versus systemic corticosteroids in IgA nephropathy: a real-world comparative study"],"prefix":"10.3389","volume":"17","author":[{"given":"Tianjiao","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huibin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Oklahoma Health Sciences Center","place":["Oklahoma City, OK, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Sui","sequence":"additional","affiliation":[{"name":"Molecular and Cellular Biology Laboratory, The Salk Institute for Biological Studies","place":["La Jolla, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuelin","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Seventh Affiliated Hospital of Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihua","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingcheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"16001","DOI":"10.2174\/1566524054553450","article-title":"Iga nephropathy","volume":"2","author":"Lai","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2021.05.021","article-title":"Kdigo 2021 clinical practice guideline for the management of glomerular diseases","volume":"100","year":"2021","journal-title":"Kidney Int"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1415463","article-title":"Intensive supportive care plus immunosuppression in iga nephropathy","volume":"373","author":"Rauen","year":"2015","journal-title":"N Engl J 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glycosylation and immune complex formation in igan","volume":"43","author":"Suzuki","year":"2021","journal-title":"Semin Immunopathol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad232","article-title":"Microscopic hematuria as a risk factor for igan progression: considering this biomarker in selecting and monitoring patients","volume":"16","author":"Zand","year":"2023","journal-title":"Clin Kidney J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2017010108","article-title":"Remission of hematuria improves renal survival in iga nephropathy","volume":"28","author":"Sevillano","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1159\/000529650","article-title":"Clinical significance of persistent hematuria degrees in primary iga nephropathy: a propensity score-matched analysis of a 10-year follow-up cohort","volume":"54","author":"Huang","year":"2023","journal-title":"Am J Nephrol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.11.008","article-title":"Persistent hematuria and kidney disease progression in iga nephropathy: a cohort study","volume":"76","author":"Yu","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2024.07.006","article-title":"Exploring novel adverse events of nefecon","volume":"9","author":"Wang","year":"2024","journal-title":"Kidney Int Rep"}],"container-title":["Frontiers in 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