SynthesisBMC nephrology2026
Targeted-release Budesonide (Nefecon) versus systemic glucocorticoids for IgA nephropathy: a placebo-anchored indirect treatment comparison of randomized controlled trials.
Synthesis in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIgA nephropathy (IgAN) is a leading cause of end-stage renal disease, particularly in East Asia. Although systemic glucocorticoids are commonly used to delay progression, they are associated with significant adverse effects. Targeted-release budesonide (Nefecon) offers localized immunosuppression, targeting the gut-associated lymphoid tissue (Peyer's patches), with the aim of reducing systemic exposure. This study evaluates the efficacy and safety of Nefecon compared to systemic glucocorticoids through a placebo-anchored indirect treatment comparison.
methodsPubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials evaluating Nefecon (16 mg/day), systemic glucocorticoids, or placebo in adults with IgAN. The primary efficacy outcome was annualized preservation of estimated glomerular filtration rate (eGFR), and secondary outcomes included annualized proteinuria reduction and serious infections. Placebo-anchored indirect treatment comparisons were performed using the Bucher difference-of-estimates method. This study was registered in PROSPERO (CRD420261357809).
resultsThree independent randomized controlled trials were included. Nefecon improved the annualized eGFR trajectory by 2.95 mL/min/1.73 m
conclusionIn this indirect comparison, both Nefecon and systemic glucocorticoids were associated with improved kidney outcomes versus placebo in IgAN. No statistically significant indirect difference was observed for eGFR preservation, while proteinuria and safety findings require cautious interpretation. Head-to-head trials are needed to further define their relative efficacy and safety.
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