Efficacy and safety of belimumab in IgA nephropathy: real-world evidence.
In a large Chinese single-centre cohort, adding the B-cell targeting drug belimumab to standard treatment for IgA nephropathy led to more patients reaching low protein levels in the urine within a year, without more common side effects.
Background
Belimumab, a monoclonal antibody targeting B lymphocyte stimulator, has demonstrated benefit in systemic lupus erythematosus and lupus nephritis, but its role in IgA nephropathy has been unclear. B-cell activation pathways are increasingly implicated in IgA nephropathy pathogenesis, making BAFF blockade a plausible target.
Study design
This retrospective cohort study at Tongji Hospital, China, enrolled biopsy-proven IgA nephropathy patients between July 2020 and June 2024. Sixty-nine patients treated with belimumab were compared with 137 propensity-score-matched controls receiving standard therapy. The primary outcome was proteinuria remission, defined as a reduction in 24-hour urinary protein excretion or urine protein-to-creatinine ratio to below 50% of baseline.
Key findings
Among 206 patients (median age 37 years, baseline eGFR 79 ml/min/1.73 m2, proteinuria 1.1 g/24 h), 173 (84%) achieved proteinuria remission within 12 months. Remission was higher with belimumab at every timepoint: 59% versus 46% at 3 months, 77% versus 66% at 6 months and 93% versus 80% at 12 months (P = 0.025 at 12 months). In newly diagnosed patients the difference was significant earlier, at 3 months (76.5% versus 47.1%, P = 0.009) and 6 months (88.2% versus 67.6%, P = 0.045).
Safety
No excess of common adverse events was observed in the belimumab group relative to standard therapy over the follow-up period reported.
Clinical implications
These real-world data suggest belimumab may add to proteinuria control in IgA nephropathy, particularly early after diagnosis, but the retrospective single-centre design and surrogate endpoint mean it should not yet displace agents with randomized eGFR-slope evidence. Prospective randomized confirmation with kidney-function endpoints is required before routine use.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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