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IgA Nephropathy

Updated : December 14, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

sparsentan 

200 mg orally every Day initially; following 14 days, increase to advised dose of 400 mg every Day
When resuming, start with 200 mg/day and then gradually increase to 400 mg/day after 14 days



Dose Adjustments

Dosage Modifications
ALT/AST >3x to ≤8x ULN
Repeat observations to verify elevation
If confirmed, discontinue medication. Once levels return to pre-treatment values and the patient is asymptomatic, monitor ALT/AST levels, bilirubin levels, and INR at least once a week.
Coadministration of strong CYP3A4 inhibitors
Avoid from coadministration
In case usage cannot be avoided, interrupt sparsentan
Renal impairment
There were no clinically significant variations in the pharmacokinetics of mild-to-moderate (eGFR 30-89 mL/min/1.73 m2) patients.
Unstudied for severe (eGFR 30 mL/min/1.73 m2)
Hepatic impairment
(Child-Pugh A-C) Mild, moderate, or severe Avoid usage as there is a danger of severe liver damage if there is any hepatic impairment.
Dosing Considerations
Before initiating
Check that women who are sexually active are not pregnant and that they are taking effective contraception.
Assess ALT, AST, and bilirubin; avoid from initiating if >3x ULN
Aliskiren, endothelin receptor antagonists, and renin-angiotensin-aldosterone system (RAAS) inhibitors should not be used anymore.
Monitoring
Prior to starting therapy, ALT, AST, and bilirubin should be monitored. For the first 12 months, they should be checked every month.
Check on women who are sexually active every month while they are receiving therapy and for one month after they stop taking the drug.

 
 

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References

IgA Nephropathy

Updated : December 14, 2022




sparsentan 

200 mg orally every Day initially; following 14 days, increase to advised dose of 400 mg every Day
When resuming, start with 200 mg/day and then gradually increase to 400 mg/day after 14 days



Dose Adjustments

Dosage Modifications
ALT/AST >3x to ≤8x ULN
Repeat observations to verify elevation
If confirmed, discontinue medication. Once levels return to pre-treatment values and the patient is asymptomatic, monitor ALT/AST levels, bilirubin levels, and INR at least once a week.
Coadministration of strong CYP3A4 inhibitors
Avoid from coadministration
In case usage cannot be avoided, interrupt sparsentan
Renal impairment
There were no clinically significant variations in the pharmacokinetics of mild-to-moderate (eGFR 30-89 mL/min/1.73 m2) patients.
Unstudied for severe (eGFR 30 mL/min/1.73 m2)
Hepatic impairment
(Child-Pugh A-C) Mild, moderate, or severe Avoid usage as there is a danger of severe liver damage if there is any hepatic impairment.
Dosing Considerations
Before initiating
Check that women who are sexually active are not pregnant and that they are taking effective contraception.
Assess ALT, AST, and bilirubin; avoid from initiating if >3x ULN
Aliskiren, endothelin receptor antagonists, and renin-angiotensin-aldosterone system (RAAS) inhibitors should not be used anymore.
Monitoring
Prior to starting therapy, ALT, AST, and bilirubin should be monitored. For the first 12 months, they should be checked every month.
Check on women who are sexually active every month while they are receiving therapy and for one month after they stop taking the drug.