Real-World Survey on Treatment Pathways and Patterns for Patients With Primary Immune Complex Membranoproliferative Glomerulonephritis

OBJECTIVES: To describe the treatment pathways for patients with primary Immune Complex Membranoproliferative Glomerulonephritis (IC-MPGN).

METHODS: Data were drawn from the Adelphi Real World IC-MPGN Disease Specific Program™, a cross-sectional survey of IC-MPGN-treating nephrologists in France, Germany, Italy, Spain and the United States of America from February–May 2024. Physicians reported patient demographics, clinical characteristics and tests used to monitor IC-MPGN over the previous 12 months of treatment, for 4 consecutively consulting patients. The patient population consisted of those both pre and post kidney transplant. Analyses were descriptive.

RESULTS: In total, 53 nephrologists provided data relating to 134 patients with primary IC-MPGN (128 adult and 6 pediatric). Mean [SD] age of patients was 44.4 [16.0] years and 56% were male. Referral patterns to the responding physician were via primary care practitioners (50%), internists (26%), other nephrologists (15%), urologists (5%) and self-referrals (2%). For most patients, the responding nephrologist initiated diagnostics to confirm IC-MPGN (90%) and initial treatment prescriptions for patients’ IC-MPGN (92%). Mean [SD] time since diagnosis was 3.1 [6.4] years. 78% of patients were receiving treatment for their IC-MPGN at data collection; treatment classes included corticosteroids (53%), biologic immunosuppressants (12%), other non-steroidal immunosuppressants (41%), angiotensin-converting enzyme inhibitors (38%), sodium-glucose cotransporter-2 inhibitors (35%), angiotensin receptor blockers (32%), and C5 inhibitors (21%). Mean [SD] urine protein excretion was 3.6 [2.6] g/24 hours at diagnosis and 2.5 [1.3] g/24 hours at data collection; mean [SD] estimated glomerular filtration rate was 45.3 [20.0] mL/min/1.73m² at diagnosis and 49.0 [21.7] mL/min/1.73 m² at data collection.

CONCLUSIONS: Nephrologists hold primary responsibility for diagnosing and treating patients with IC-MPGN following referrals from primary care. Despite treatment with conventional therapy, proteinuria remained elevated which suggests the need for more effective treatment options for this patient population.