{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:25:02Z","timestamp":1787034302892,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"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>Targeted-release budesonide (Nefecon) has demonstrated efficacy in IgA nephropathy (IgAN) trials, yet real-world data across disease severity spectrum remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter, retrospective cohort study included 148 biopsy-proven IgAN adults (Nefecon =79; RASi =69). Primary endpoints were 9-month changes in proteinuria and eGFR. Mahalanobis distance matching within propensity score calipers addressed baseline imbalances. Response dynamics and safety were secondarily evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Despite worse baseline eGFR (median 54.2 vs. 85.3 mL\/min\/1.73m\u00b2; P &amp;lt; 0.001) and more severe pathological lesions in the Nefecon group compared to RASi group, Nefecon was associated with greater proteinuria reduction (-1.25 vs. \u20130.58 g\/24h; P &amp;lt; 0.001) and favorable eGFR trajectories (+2.7 vs. -11.2 mL\/min\/1.73m\u00b2; between-group difference 13.9 mL\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% CI 12.7 to 15.1; P &amp;lt;0.001), findings remained largely consistent after Mahalanobis distance matching adjustment. Complete and partial remission rates were higher (29.1% and 54.2% vs. 10.1% and 23.2%; P &amp;lt; 0.001), with 59.5% achieving \u226550% proteinuria reduction versus 21.7% (RR 2.70, 95% CI 1.62\u20134.51). Treatment effects varied by baseline disease severity. Enhanced antiproteinuric efficacy was observed in patients with proteinuria &amp;gt;1.5 g\/24h (interaction P\u00a0=\u00a00.003), while kidney function preservation was most pronounced in those with eGFR &amp;lt;60 mL\/min\/1.73m\u00b2. Notably, 51.1% of initial non-responders achieved remission by 9 months, with complete remission rates increasing 4.6-fold over time. Adverse events were consistent with corticosteroid exposure; menstrual disturbance occurred in 39.5% of females. Serious adverse events were rare (2.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This real-world observational analysis shows Nefecon associated with improved proteinuria and eGFR outcomes across IgAN severity, extending randomized trial evidence to patients with advanced CKD and revealing substantial delayed response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1860166","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:35:59Z","timestamp":1787031359000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world multicenter evidence on Nefecon for attenuating proteinuria and kidney function decline in IgA nephropathy"],"prefix":"10.3389","volume":"17","author":[{"given":"Shasha","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanping","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]},{"name":"National Health Commission (NHC) Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, 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