A nurse in blue scrubs checks the blood pressure of a smiling woman in a pink shirt at a clinic.

IgA Nephropathy Treatments Compared

Name: IgA Nephropathy Treatments Compared
Creator: Jason Hunter
Published: 2026-10-01

6 FDA-approved drugs and 5 in development, side by side from the current prescribing labels. Newest label Aug 2026. Checked October 1, 2026.

Full approval, kidney functionTarpeyo · Filspari · Fabhalta

Accelerated approval, proteinuriaVanrafia · Trutakna · Voyxact

Six drugs are FDA-approved specifically for IgA nephropathy, all since December 2021, and they divide into 2 tiers. Tarpeyo, Filspari and Fabhalta hold full approval to slow the loss of kidney function, with eGFR results on their labels. Vanrafia, Trutakna and Voyxact hold accelerated approval based on lowering protein in the urine, and their labels say it is not yet established that they slow kidney decline, although Trutakna and Voyxact have since reported positive 2-year eGFR results. Four are pills, Trutakna is a weekly self-injection and Voyxact is a self-injection every 4 weeks. Five more drugs are in Phase 3 or under FDA review, with decisions on povetacicept and Ultomiris expected before the end of 2026.

Side by side

6 approved IgA nephropathy treatments at a glance

How each drug is given, how often, who it is approved for and when it was first approved, from the current FDA label.

IgA Nephropathy treatments compared: route, schedule, approved use and approval date
Drug	How it is given	How often	Approved for	First approved
Tarpeyo budesonide delayed-release capsules Calliditas Therapeutics	Capsule by mouth once a day, for a 9-month course	16 mg once daily in the morning for 9 months, then 8 mg once daily for the last 2 weeks	Adults with primary IgAN at risk of disease progression, to reduce loss of kidney function	December 15, 2021
Filspari sparsentan Travere Therapeutics	Tablet by mouth once a day	200 mg once daily for 14 days, then 400 mg once daily; must stop ACE inhibitors and ARBs first	Adults with primary IgAN at risk of disease progression, to slow kidney function decline	February 17, 2023
Fabhalta iptacopan Novartis	Capsule by mouth twice a day	200 mg twice daily, with or without food; vaccination against encapsulated bacteria at least 2 weeks before starting	Adults with primary IgAN at risk of disease progression, to slow kidney function decline	August 7, 2024
Vanrafia atrasentan Novartis	Tablet by mouth once a day	0.75 mg once daily, with or without food; pregnancy must be ruled out before starting	Adults with primary IgAN at risk of rapid progression (generally UPCR 1.5 g/g or higher), to reduce proteinuria	April 2, 2025
Trutakna atacicept-vymj Vera Therapeutics	Shot under the skin once a week, self-injected at home	150 mg subcutaneously once weekly with an autoinjector, in the abdomen or thigh	Adults with primary IgAN at risk of disease progression, to reduce proteinuria	July 7, 2026
Voyxact sibeprenlimab-szsi Otsuka	Shot under the skin once every 4 weeks, self-injected at home	400 mg subcutaneously once every 4 weeks with a prefilled syringe, in the thigh or abdomen	Adults with primary IgAN at risk of disease progression, to reduce proteinuria	November 25, 2025

The calendar

A year on each IgA nephropathy treatment

Every dose in a year, drawn to the label schedule, so the difference between a daily pill and a twice-yearly infusion is the picture.

Tarpeyo

By mouth, at home

16 mg once daily in the morning for 9 months, then 8 mg once daily for the last 2 weeks (no fixed yearly count)

Filspari

By mouth, at home

365 doses a year

Fabhalta

By mouth, at home

730 doses a year

Vanrafia

By mouth, at home

365 doses a year

Trutakna

Injection, at home

52 doses a year

Voyxact

Injection, at home

13 doses a year

Counts follow the label schedule for a full year on the maintenance dose. Drugs given in cycles or adjusted to blood tests have no fixed count, so their schedule is written out instead.

The evidence

What the pivotal IgA nephropathy trials showed

The primary result from the trial each FDA approval rests on, as reported on the label.

Before you compare

How to read the IgA nephropathy trial results

1
Proteinuria results are not like-for-like
Trials measured urine protein at different time points, 9 months for Tarpeyo, Fabhalta and Voyxact and week 36 for Filspari, Vanrafia and Trutakna, against different placebo responses. Filspari was compared with the blood pressure drug irbesartan rather than placebo, and it requires stopping ACE inhibitors and ARBs, while every other drug is added on top of them.
2
Tarpeyo is a fixed 9-month course followed by a 2-week taper
The other 5 are taken for as long as they work.
3
Three drugs carry boxed warnings
Filspari for liver injury and birth defects, Vanrafia for birth defects, and Fabhalta for serious infections from encapsulated bacteria. Filspari and Fabhalta require enrollment in a safety program.

IgA Nephropathy pivotal trial results by drug
Drug	Pivotal trial	Primary result
Tarpeyo budesonide delayed-release capsules Calliditas Therapeutics	NefIgArd, 364 adults in the efficacy analysis (389 treated) Trial record or paper	At 2 years, eGFR was 5.9 mL/min/1.73 m2 better than placebo; at 9 months UPCR was 31% lower than placebo
Filspari sparsentan Travere Therapeutics	PROTECT, 404 adults Trial record or paper	UPCR fell 45% vs 15% on irbesartan at week 36 (35% relative reduction); eGFR declined 1.2 mL/min/1.73 m2 per year less over 110 weeks
Fabhalta iptacopan Novartis	APPLAUSE-IgAN, 477 adults Trial record or paper	eGFR declined 3.0 vs 5.7 mL/min/1.73 m2 per year on placebo over 24 months (2.8 per year difference); UPCR 38% lower than placebo at 9 months
Vanrafia atrasentan Novartis	ALIGN, 403 adults (270 in the primary analysis) Trial record or paper	UPCR fell 38% vs 3% on placebo at week 36 (36% reduction vs placebo)
Trutakna atacicept-vymj Vera Therapeutics	ORIGIN 3, 428 adults (203 in the primary analysis) Trial record or paper	UPCR fell 46% vs 7% on placebo at week 36 (42% reduction vs placebo)
Voyxact sibeprenlimab-szsi Otsuka	VISIONARY, 510 adults (320 in the interim analysis) Trial record or paper	UPCR fell 50% vs a 2% rise on placebo at month 9 (51% reduction vs placebo)

Safety

IgA Nephropathy treatment side effects and warnings

Filspari, Fabhalta and Vanrafia carry a boxed warning, the FDA's strongest. The rest list their main precautions.

IgA Nephropathy treatments: most common side effects and key warnings from the FDA labels
Drug	Most common side effects	Key warning
Tarpeyo budesonide delayed-release capsules Calliditas Therapeutics	peripheral edema 17%, hypertension 12% and muscle spasms 12%	No boxed warning. Steroid effects: adrenal suppression (taper when stopping), higher infection risk, and worsening of high blood pressure or diabetes.
Filspari sparsentan Travere Therapeutics	hyperkalemia 17%, hypotension 16% and peripheral edema 16%	Boxed warning Boxed warning: liver toxicity and birth defects. Liver tests every 3 months and pregnancy must be ruled out; available only through the Filspari REMS program.
Fabhalta iptacopan Novartis	abdominal pain 8%, dizziness 5% and nausea 4%	Boxed warning Boxed warning: serious infections from encapsulated bacteria (meningococcal, pneumococcal, Hib). Vaccination required; available only through the Fabhalta REMS program.
Vanrafia atrasentan Novartis	peripheral edema 10%, anemia 6% and liver transaminase elevation 2%	Boxed warning Boxed warning: birth defects. Contraindicated in pregnancy; effective contraception required. Also liver toxicity and fluid retention.
Trutakna atacicept-vymj Vera Therapeutics	infections 32% (28% on placebo), injection site reactions 30% (5% on placebo) and upper respiratory tract infection 12%	No boxed warning. Higher infection risk; no live vaccines within 30 days before or during treatment.
Voyxact sibeprenlimab-szsi Otsuka	infections 49% (45% on placebo), injection site reactions 24% (23% on placebo) and upper respiratory infection 15%	No boxed warning. Higher infection risk; no live vaccines within 30 days before or during treatment.

Not yet approved

IgA nephropathy treatments in Phase 3 or under FDA review

Investigational drugs with a Phase 3 trial, shown separately because their results are not from a label. Status as of the date in each row.

IgA Nephropathy drugs in development
Drug	Status	How it works and is given	Pivotal trial	Result so far	What is next
povetacicept Vertex Pharmaceuticals (Alpine Immune Sciences)	Under FDA reviewas of October 1, 2026	Dual BAFF and APRIL blocker (engineered TACI fusion protein) that lowers harmful IgA productionShot under the skin every 4 weeks (80 mg); planned as a home autoinjector	RAINIER, Phase 3, 605 peoplePrimary endpoint: UPCR change at week 36 (interim); eGFR slope through week 104 (final) ClinicalTrials.gov	Met primary endpoint: UPCR fell 52.0% vs 4.3% on placebo at week 36, a 49.8% reduction vs placebo in 199 people (Vertex press release, 2026-03-09)	FDA decision date (PDUFA) November 30, 2026, for accelerated approval Vertex press release, June 1, 2026
ravulizumab (Ultomiris) Alexion (AstraZeneca)	Under FDA reviewas of October 1, 2026	Long-acting complement C5 blocker that stops complement-driven inflammation in the kidneyIV infusion at a clinic every 8 weeks after a loading dose, weight-based	I CAN, Phase 3, 579 peoplePrimary endpoint: UPCR change at week 34 (interim); eGFR change at week 106 (final) ClinicalTrials.gov	Met first primary endpoint: UPCR fell 46.6% vs 5.6% on placebo at week 34, a 43.4% reduction vs placebo (AstraZeneca press release, 2026-06-15, citing ERA Congress 2026)	FDA decision anticipated in the fourth quarter of 2026 (priority review) AstraZeneca press release, June 15, 2026
sefaxersen Roche (licensed from Ionis)	Phase 3as of October 1, 2026	Antisense oligonucleotide that lowers complement factor B made by the liverShot under the skin once a month, designed for self-injection	IMAgINATION, Phase 3, 459 peoplePrimary endpoint: UPCR change at week 37 ClinicalTrials.gov	Met primary endpoint at a prespecified interim analysis; Roche has not released the size of the proteinuria reduction (Roche press release, 2026-09-23)	No date announced Roche media release, September 23, 2026
zigakibart Novartis	Phase 3as of October 1, 2026	Anti-APRIL antibody that lowers harmful IgA productionShot under the skin every 2 weeks (600 mg)	BEYOND, Phase 3, 383 peoplePrimary endpoint: eGFR change from baseline at 104 weeks ClinicalTrials.gov	No trial results published yet	Novartis expects the BEYOND readout in the first half of 2027 Novartis Q2 2026 media release, July 21, 2026
felzartamab Biogen	Phase 3as of October 1, 2026	Anti-CD38 antibody that removes the plasma cells making harmful IgAIV infusion at a clinic	PREVAIL, Phase 3, about 454 people (planned)Primary endpoint: UPCR percent change at week 36 ClinicalTrials.gov	No trial results published yet	No date announced ClinicalTrials.gov NCT06935357, updated September 30, 2026

Cost

Help paying for IgA nephropathy treatment

Drugmaker copay and free-drug programs, plus charity funds for the condition, checked every week.

Questions

IgA Nephropathy treatment questions people ask

What is the best treatment for IgA nephropathy?

No trial has compared the 6 approved drugs with each other, so there is no evidence-based ranking. Tarpeyo, Filspari and Fabhalta have shown on their labels that they slow the loss of kidney function over 2 years. Vanrafia, Trutakna and Voyxact were approved on protein reduction and are still confirming kidney benefit. The right choice depends on how much protein is in the urine, kidney function, whether a pill or an injection fits your life, and whether you can stop ACE inhibitors or ARBs, which Filspari requires.

Which IgA nephropathy drugs are pills?

Tarpeyo (capsule once a day for 9 months), Filspari (tablet once a day), Fabhalta (capsule twice a day) and Vanrafia (tablet once a day). Trutakna is a shot under the skin once a week and Voyxact a shot every 4 weeks, both self-injected at home.

What new IgA nephropathy drugs are coming?

As of October 2026, povetacicept has an FDA decision date of November 30, 2026, and Ultomiris (ravulizumab) has a decision expected in the fourth quarter of 2026 under priority review. Sefaxersen met its Phase 3 primary endpoint in September 2026 but Roche has not released the numbers. Zigakibart's Phase 3 readout is expected in the first half of 2027 and felzartamab is in Phase 3. The pipeline table on this page lists each one with its trial.

Which IgA nephropathy treatments have a boxed warning?

Filspari, for liver injury and harm to a fetus; Vanrafia, for harm to a fetus; and Fabhalta, for serious infections caused by encapsulated bacteria, which requires vaccination before starting. Tarpeyo, Trutakna and Voyxact have no boxed warning.

Does Tarpeyo cure IgA nephropathy?

No. Tarpeyo is a 9-month course of a targeted-release steroid that, in its trial, left kidney function 5.9 mL/min/1.73 m2 better than placebo at 2 years and lowered urine protein by 31% more than placebo at 9 months. The kidney function benefit held after the course ended, but the label notes it did not change the long-term rate of decline, and the disease itself is not removed.

Go deeper

More on IgA Nephropathy at Trial Friend

Sources

Where every number on this page comes from

Approved-drug facts are from the current FDA prescribing information on DailyMed, with the label's effective date. Investigational-drug facts are from ClinicalTrials.gov and the sources named in each row.

Tarpeyo (budesonide delayed-release capsules) prescribing information, Calliditas Therapeutics, label dated Jan 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Filspari (sparsentan) prescribing information, Travere Therapeutics, label dated Apr 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Fabhalta (iptacopan) prescribing information, Novartis, label dated Jul 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Vanrafia (atrasentan) prescribing information, Novartis, label dated Jun 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Trutakna (atacicept-vymj) prescribing information, Vera Therapeutics, label dated Aug 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Voyxact (sibeprenlimab-szsi) prescribing information, Otsuka, label dated Mar 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
povetacicept, Vertex Pharmaceuticals (Alpine Immune Sciences): ClinicalTrials.gov record; Vertex press release, June 1, 2026. Checked October 1, 2026.
ravulizumab (Ultomiris), Alexion (AstraZeneca): ClinicalTrials.gov record; AstraZeneca press release, June 15, 2026. Checked October 1, 2026.
sefaxersen, Roche (licensed from Ionis): ClinicalTrials.gov record; Roche media release, September 23, 2026. Checked October 1, 2026.
zigakibart, Novartis: ClinicalTrials.gov record; Novartis Q2 2026 media release, July 21, 2026. Checked October 1, 2026.
felzartamab, Biogen: ClinicalTrials.gov record; ClinicalTrials.gov NCT06935357, updated September 30, 2026. Checked October 1, 2026.

This page compares what the FDA labels and pivotal trials report. It is not medical advice, and no trial on this page compared these drugs with each other. Written and checked by Jason Hunter; the method is on the editorial standards page.