Efficacy and Safety of Sparsentan Versus Irbesartan
in Patients With IgA Nephropathy (PROTECT):
2-year Results From a Randomised,
Active-Controlled, Phase 3 Trial
Topics: Nephrology IgAN Sparsentan PROTECT Clinical Infographic Publication Summary Video
Rovin BH, Barratt J, Heerspink HJL et al.
10.1016/S0140-6736(23)02302-4
Summary
Background
- IgA nephropathy is a rare kidney disease. It can lead to progressive kidney function decline and kidney failure within 10 to 20 years of diagnosis1,2
- Endothelin-1 (ET-1) and angiotensin II (Ang II) are two critical peptides that act in tandem and are responsible for the progression of IgA nephropathy over time3,4
- Sparsentan is an FDA approved non-immunosuppressive, single-molecule, Dual Endothelin Angiotensin Receptor Antagonist (DEARA) indicated to slow kidney function decline in adults with primary IgA nephropathy who are at risk for disease progression5,6
Aim
The PROTECT study evaluates long-term efficacy and safety of sparsentan versus irbesartan in IgA nephropathy6
PROTECT: A large, international, randomized,
double-blind, active controlled Phase 3 trial
Key findings
Sparsentan met its primary endpoint showing superior reductions in proteinuria from baseline to Week 36 versus irbesartan. This reduction was sustained over 2 years5-7
The absolute LS mean change in eGFR from baseline to Week 110 was smaller with sparsentan versus irbesartan, demonstrating a greater preservation of kidney function with sparsentan5,6
The safety profile of sparsentan is comparable with that of irbesartan5,6
The most common AEs with sparsentan were hyperkalemia,† hypotension, peripheral edema,† dizziness,† anemia, acute kidney injury, and transaminase elevations5‡
Most common AEs are per the FDA US Prescribing Information
There were no instances of drug-induced liver injury or discontinuations due to heart failure or edema6
Resources
Conclusions
Sparsentan demonstrated5,6:
Projected eGFR data of sparsentan and irbesartan suggest prolonged kidney survival with sparsentan6
Footnotes
*Participants were enrolled between December 2018 and May 2021.6 †Includes related terms.5 ‡Elevations in ALT or AST greater than 3-fold ULN.5
AE, adverse event; ALT, alanine aminotransferase; Ang II, angiotensin II; AST, aspartate aminotransferase; AT1R, angiotensin II subtype 1 receptor; DEARA, Dual Endothelin Angiotensin Receptor Antagonist; eGFR, estimated glomerular filtration rate; ET-1, endothelin 1; ETAR, endothelin type A receptor; FDA, Food and Drug Administration; IgA, immunoglobulin A; ULN, upper limit of normal; UPCR, urine protein-creatinine ratio.
- Kwon CS et al. J Health Econ Outcomes Res. 2021;8(2):36-45.
- Pitcher D et al. Clin J Am Soc Nephrol. 2023;18(6):727-738.
- Martínez-Díaz I et al. Int J Mol Sci. 2023;24(4):3427.
- Komers R, Plotkin H. Am J Physiol Regul Integr Comp Physiol. 2016;310(10):R877-884.
- FILSPARI® (sparsentan) Prescribing Information. San Diego, CA: Travere Therapeutics, Inc.
- Rovin BH et al. Lancet. 2023;402(10417):2077-2090.
- Heerspink HJL et al. Lancet. 2023;401(10388):1584-1594.
MA-SP-24-0049 | October 2025