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Immunoglobulin A nephropathy (IgAN) is the most common primary glomerular disease worldwide with many patients progressing to advanced kidney disease despite maximization of supportive measures, including optimization of renin-angiotensin system blockade. Sodium glucose co-transporter 2 (SGLT2) inhibitors, a class of drug originally intended for decreasing blood glucose in diabetes, have been shown to reduce the risk of kidney disease progression in both diabetic and non-diabetic kidney disease, including IgAN. As a result, regulatory approval to expand their use to non-diabetic kidney disease has been granted in some regions, but their adoption has been variable worldwide. The aim of this study was to explore the utilization of SGLT2 inhibitors in non-diabetic kidney disease and compare SGLT2 inhibitor adoption and reimbursement in the treatment of IgAN across regions.
The George Clinical Scientific Leadership Team interviewed and surveyed nephrologists, considered to be key opinion leaders, in 32 countries worldwide between August - October 2023. Details regarding regulatory approval of SGLT2 inhibitors in non-diabetic kidney disease, and prescribing practices and cost reimbursement of SGLT2 inhibitors in the treatment of IgAN in each country were obtained.
The response rate was 75% (24/32 countries) with representation from four regions (Asia Pacific (APAC), Europe/Middle East (EMEA), North America (NA) and Latin America (LATAM)). Most responses were from APAC (10/24) and EMEA (10/24) countries, with nephrologists in two LATAM (2/24) and two NA (2/24) countries responding also.
Of the countries where nephrologists responded to the survey, 79% (19/24) reported regulatory approval of SGLT2 inhibitors for the treatment of non-diabetic kidney disease (Figure 1). However, in countries where the approval of SGLT2 inhibitors for the treatment of non-diabetic kidney disease were reported, their cost was only partially reimbursed by public health care systems for the treatment of IgAN in 47% (9/19) of countries, and not reimbursed at all in 26% (5/19) of countries. Full cost reimbursement varied from 0% of responding nephrologists in NA and LATAM to 14% in APAC and 50% in EMEA (Table 1).
Table 1 – Reimbursement rates from countries reporting regulatory approval of SGLT2 inhibitors
Despite proven clinical benefits, regulatory approval for the use of SGLT2 inhibitors in non-diabetic kidney disease was not reported by nephrologists in all countries surveyed. Furthermore, in countries reporting regulatory approval, SGLT2 inhibitors were only partially reimbursed or not reimbursed at all for the treatment of IgAN in the majority of countries, which may significantly limit their accessibility for patients. Further work to be presented will detail clinical thresholds for reimbursement of SGLT2 inhibitor use in each country, and patterns of use in IgAN.