Efficacy and safety of budesonide for the treatment of IgA nephropathy: a systematic review and meta-analysis.
Rayyan Nabi, Muhammad Ansab, Amna Hussain et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed the efficacy and safety of budesonide formulations in people with biopsy-proven IgA nephropathy. Nine studies involving 465 participants, including two randomised controlled trials, were analysed. In placebo-controlled comparisons, targeted-release budesonide attenuated eGFR decline (weighted mean difference 4.53 mL/min/1.73 m²; 95% CI 3.08–5.99) and reduced urine protein-to-creatinine ratio by 28.96% relative to placebo. Adverse events were more frequent with budesonide than placebo (RR 1.18; 95% CI 1.01–1.38). The authors note that limited trial data and follow-up constrain conclusions about long-term benefit and safety.
Key findings
- In placebo-controlled trials, targeted-release budesonide attenuated eGFR decline by 4.53 mL/min/1.73 m² (95% CI 3.08-5.99).
- UPCR percentage change was lower with targeted-release budesonide than placebo (MD -28.96%; 95% CI -45.94 to -11.99).
- Adverse events were more likely with budesonide than placebo (RR 1.18; 95% CI 1.01-1.38).
- Uncontrolled cohorts reported pooled adverse event rates of 40% with targeted-release budesonide and 44% with enteric-coated formulations.
Why it matters
The findings suggest that targeted-release budesonide may improve kidney-function and proteinuria measures in IgA nephropathy, while also carrying a higher adverse-event risk than placebo. These outcomes are relevant to assessing the balance of potential benefit and harm, but the evidence does not establish long-term kidney benefit or safety.
What to keep in mind
The review included only two randomised trials; the authors also cite heterogeneity, short follow-up, and sparse histologic end points, limiting conclusions about long-term outcomes.