This Week's Paper
Annotate, discuss, and earn CME credit. Join 50 nephrologists in this week's discussion.
1.0 CME Credit AvailableSparsentan in IgA Nephropathy: Two-Year Outcomes from the PROTECT Trial
Dual endothelin-angiotensin receptor antagonism demonstrates durable proteinuria reduction and eGFR preservation
◆ CLINICAL BOTTOM LINE
Editor's Annotations
"Sparsentan reduced proteinuria by 49% versus 15% with irbesartan (p<0.001)"
This is the largest proteinuria reduction seen in any IgA nephropathy trial to date.
— Dr. J. Wei
"eGFR slope was significantly less steep (-2.9 vs -3.9 mL/min/1.73m²/year)"
Clinically meaningful difference — projects to ~10 mL/min/1.73m² difference over 10 years.
— Dr. S. Kim
Discussion (50 comments)
Dr. Sarah Kim
Stanford Nephrology · 2 hours ago
The 49% proteinuria reduction is impressive, but I'm concerned about the edema rate. In my practice, about 20% of patients discontinue due to fluid retention. Has anyone found strategies to mitigate this?
Dr. Raj Patel
Mayo Clinic · 4 hours ago
The eGFR slope data is what I find most compelling. A 1 mL/min/year difference may seem modest, but compounded over a decade, that's the difference between dialysis and not.
Dr. Elena Vasquez
Columbia University · 6 hours ago
Important to note the REMS program requirements. We've had to build a separate workflow for female patients of childbearing potential. The teratogenicity risk requires systematic counseling at every visit.