New Treatments for IgA Nephropathy: What Has Changed

For decades, treating IgA nephropathy meant one thing: protect the kidneys with blood-pressure control and supportive care, and reserve steroids for selected patients. That foundation still matters — but since December 2021 the US Food and Drug Administration (FDA) has approved the first medicines developed specifically for this condition, and more have followed. This article explains what has changed, in plain language. It follows our main guide, What Is IgA Nephropathy?, and the IgA nephropathy hub.

The short version

Seven medicines are now FDA-approved specifically for IgA nephropathy. Three hold full approval, backed by data on kidney function itself. Four were approved more quickly — "accelerated" approval — based on reducing protein in the urine, with their kidney-function studies still being completed or assessed. All of them are added on top of supportive care, not instead of it, and none of them is a cure.

The foundation has not changed

Every treatment plan still starts with supportive care: blood-pressure control, usually with an ACE inhibitor or ARB (which also lowers protein in the urine); salt reduction; cholesterol and smoking addressed; and, for many people, an SGLT2 inhibitor — a class first developed for diabetes that protects kidneys in proteinuric kidney disease. The newer medicines below are considered for selected patients whose risk remains higher despite this foundation.

Targeted-release budesonide

Budesonide is a steroid, but this formulation is engineered to release in the part of the gut where much of the abnormal IgA is thought to originate — aiming at the source of the problem rather than suppressing the whole immune system. It was the first treatment approved specifically for IgA nephropathy (US brand name Tarpeyo; Kinpeygo in Europe): accelerated approval in December 2021 based on reducing urine protein, then full approval in December 2023 to reduce the loss of kidney function in adults at risk of progression.

Sparsentan

Sparsentan (brand name Filspari) combines two actions in one tablet: it blocks both angiotensin (like an ARB) and endothelin, another pathway that raises pressure inside the kidney filters and drives protein leakage and scarring. It is a non-immunosuppressive medicine. The FDA granted it accelerated approval in February 2023, and full approval in September 2024 to slow kidney function decline in adults with primary IgA nephropathy at risk of progression. It carries its own specific safety-monitoring requirements.

Atrasentan

Atrasentan (brand name Vanrafia) is a selective endothelin A receptor blocker — it works on the same pathway family as sparsentan, but as a single-action medicine. It received FDA accelerated approval in April 2025 to reduce protein in the urine in adults with primary IgA nephropathy at risk of rapid progression.

Targeting the signals behind abnormal IgA

Two newer injected medicines act further upstream, on the immune signals that drive production of the abnormal IgA itself. Sibeprenlimab (brand name Voyxact) blocks one of these signals, called APRIL; it received FDA accelerated approval in November 2025 to reduce protein in the urine in adults with primary IgA nephropathy at risk of progression. Atacicept (brand name Trutakna) blocks two signals, BAFF and APRIL — the first approved treatment to target both — and received FDA accelerated approval in July 2026 for the same purpose.

The complement pathway

In IgA nephropathy, the complement system — part of the immune system — helps turn IgA deposits into inflammation. Iptacopan (brand name Fabhalta) is a tablet that blocks one complement protein, factor B. After an accelerated approval in August 2024 based on urine protein, it received traditional (full) FDA approval in July 2026 to slow kidney function decline in adults with primary IgA nephropathy at risk of progression. Ravulizumab (brand name Ultomiris) blocks a different complement protein, C5, and received FDA accelerated approval in October 2026 to reduce protein in the urine — the first C5 inhibitor approved for this condition. Both complement medicines come with specific safety monitoring, because this pathway is also part of the body's defence against infection.

What "approved on protein" means

Several of these approvals are "accelerated": regulators accepted a fall in urine protein as evidence the treatment is reasonably likely to help, because high protein reliably predicts faster kidney decline. Full approval requires the longer studies showing the treatment actually slows the loss of kidney function — the step budesonide, sparsentan and iptacopan have now completed. For the accelerated approvals, those longer studies are still being completed or assessed, and continued approval can depend on their results. Guidelines are being updated as the evidence matures — the KDIGO guideline for this condition was refreshed in 2025. More medicines are in late-stage trials, but anything not yet approved should be regarded as experimental.

Who are these treatments for?

Generally, they are considered for adults whose urine protein remains high despite full supportive care and who are judged at risk of progression — the exact criteria differ by medicine and country, and each has its own safety monitoring. They are not for everyone with IgA nephropathy, and none replaces monitoring. If your protein levels have stayed high, it is reasonable to ask your specialist whether any of the newer options fit your situation.

References & further reading

KDIGO — 2025 Clinical Practice Guideline for the Management of IgA Nephropathy (IgAN) and IgA Vasculitis (IgAV): https://kdigo.org/guidelines/iga-nephropathy/

US Food and Drug Administration — Drug Trials Snapshot: Voyxact (sibeprenlimab): https://www.fda.gov/drugs/drug-trials-snapshots/drug-trials-snapshots-voyxact

National Kidney Foundation — IgA Nephropathy: https://www.kidney.org/kidney-topics/iga-nephropathy

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — IgA Nephropathy: https://www.niddk.nih.gov/health-information/kidney-disease/iga-nephropathy

This article is for general education only and is not medical advice. Newer IgA nephropathy treatments are prescription medicines with individual eligibility and monitoring requirements — decisions belong with your kidney specialist.