IgA nephropathy affects an estimated 10,000–15,000 UK patients and drives 10–12% of incident UK end-stage renal disease, a burden NICE built into a £40–50M-a-year economic case for the budesonide and sparsentan appraisals.
IgA nephropathy (IgAN) is an immune-mediated glomerulonephritis caused by mesangial deposition of galactose-deficient IgA1, driving progressive proteinuria and declining eGFR. The UK Renal Registry (2023) identifies IgAN as the UK's second most common primary glomerulonephritis after membranous nephropathy, with an estimated 10,000–15,000 UK patients and approximately 500 new diagnoses per year confirmed via kidney biopsy. IgAN accounts for 10–12% of incident UK end-stage renal disease (ESRD) — roughly 1,000–1,200 UK ESRD cases per year. A network of approximately 80 NHS specialist nephrology centres performs the confirmatory biopsies, giving the UK a comparatively high diagnosis rate.
The Renal Association IgAN guideline (2023, aligned with KDIGO 2021) directs optimal ACEi/ARB therapy for 3–6 months before considering novel agents, targeting blood pressure below 130/80mmHg and UPCR below 0.5g/g. Corticosteroid immunosuppression remains controversial following the STOP-IgAN trial's null result in high-risk patients, with SGLT2 inhibition now being explored. Both novel agents have since cleared NICE technology appraisal: targeted-release budesonide under TA937 (2023, updated by TA1128 in 2026) and sparsentan under TA1074 (June 2025), following MHRA approval of sparsentan in April 2025 — moving IgAN novel-agent access from Named Patient Programme into mainstream NHS commissioning.
UK IgAN treatment landscape — NICE-recommended novel agents against the ACEi/ARB-optimised standard of care
| Drug | Class | Company | MHRA/NICE Status | Key Evidence |
|---|---|---|---|---|
| Tarpeyo (targeted-release budesonide) | Oral targeted glucocorticoid | Calliditas / AstraZeneca | MHRA approved 2023; NICE TA937 (2023), updated by TA1128 (Feb 2026), recommends for NHS funding with a patient access scheme | NefIgArd trial: eGFR slope benefit |
| Filspari (sparsentan) | Dual endothelin/angiotensin receptor antagonist | Travere Therapeutics / CSL Vifor | MHRA approved April 2025; NICE TA1074 (June 2025) recommends for NHS funding — first DEARA approved in this indication | PROTECT trial: UPCR −49.8% |
Sources: UK Renal Registry 2023 annual report; Renal Association IgAN guideline 2023; NICE TA937/TA1128 (budesonide) and TA1074 (sparsentan); NHS PbR tariff 2023–24.
What this assessment answers
Every section answers a named commercial question your team is asking, scoped to your asset.
Delivers
- UK Renal Registry population sizing
- ACEi/ARB-optimised vs novel-agent-eligible segmentation
- biopsy-confirmed diagnosis rate by NHS nephrology centre
Delivers
- NHS renal replacement therapy tariff data (haemodialysis, peritoneal dialysis, transplant)
- IgAN-attributable ESRD cost burden
- NICE cost-effectiveness framing for eGFR-slope-benefit agents
Delivers
- NefIgArd and PROTECT trial evidence summary
- NICE TA937/TA1128 (budesonide) and TA1074 (sparsentan) recommendations and funding timelines
- comparative positioning against the ACEi/ARB-optimised standard of care
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Commission This AssessmentWhat's inside
- How mesangial deposition of galactose-deficient IgA1 drives the progressive proteinuria and eGFR decline that define IgAN
- Why IgAN ranks as the UK's second most common primary glomerulonephritis after membranous nephropathy
- How the UK Renal Registry's biopsy-confirmed data puts the UK IgAN population at 10,000-15,000 patients with roughly 500 new diagnoses a year
- Why the network of roughly 80 NHS specialist nephrology centres performing confirmatory biopsies gives the UK a comparatively high diagnosis rate
- How the Renal Association's 2023 guideline, aligned with KDIGO 2021, mandates 3-6 months of ACEi/ARB optimisation targeting UPCR below 0.5g/g
- Why corticosteroid immunosuppression remains controversial after STOP-IgAN's null result, pushing focus toward SGLT2 inhibition
- Why IgAN accounts for 10-12% of incident UK end-stage renal disease, roughly 1,000-1,200 cases a year
- How this translates into an estimated £40-50 million annual NHS economic burden from IgAN-attributable ESRD
- NefIgArd's eGFR-slope benefit for targeted-release budesonide versus PROTECT's -49.8% UPCR reduction for sparsentan, the first DEARA in this indication
- How these two mechanistically distinct novel agents both build their case on delaying progression rather than reversing existing damage
- How budesonide's TA937 (2023, updated by TA1128 in 2026) and sparsentan's TA1074 (June 2025) moved IgAN access into mainstream NHS commissioning
- Why sparsentan's April 2025 MHRA approval preceded its NICE TA1074 recommendation by just two months, an unusually fast sequence
Included with every brief
How AXLRx builds this assessment
Prepared by MoatRx analysts.
UK IgAN disease landscape is built from UK Renal Registry annual reporting, the Renal Association IgAN guideline (aligned with KDIGO 2021), and NHS Payment by Results (PbR) tariff data underpinning the ESRD cost-offset case for novel agents. The UK Renal Registry's biopsy-confirmed cohort gives IgAN unusually reliable UK epidemiological data relative to most rare kidney diseases.
Key sources: UK Renal Registry 2023 annual report; Renal Association IgAN guideline 2023; KDIGO IgAN 2021 guideline; NHS PbR tariff 2023–24; NICE scope for IgAN technology appraisals 2024. All figures carry source citations and are triangulated across multiple primary sources.
- UK IgAN population and ESRD share verified against UK Renal Registry 2023 annual report
- NHS management pathway verified against Renal Association IgAN guideline 2023 and KDIGO IgAN 2021 guideline
- NHS renal replacement therapy cost data verified against NHS PbR tariff 2023–24
- NICE appraisal scope and timeline verified against NICE scope for IgAN technology appraisals 2024
Frequently asked questions
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AXLRx IgA Nephropathy Disease Landscape is built for commercial, medical affairs, and market access teams that need a rigorous, evidence-based characterisation of the UK IgAN patient population and the NHS economic case for novel agents. Custom assessment in 72 hours.
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