Treatment

Primary GNmedium

A 38-year-old woman with IgA nephropathy has persistent proteinuria of 2.2 g/day despite maximally tolerated RAS blockade and optimized supportive care. Which of the following agents demonstrated a significant reduction in proteinuria in a phase 3, placebo-controlled trial in IgA nephropathy?

  1. A.AtaciceptCorrect
  2. B.Rituximab
  3. C.Hydroxychloroquine
  4. D.Fish oil (omega-3 fatty acids)

Explanation

Atacicept, a TACI-Fc fusion protein that inhibits BAFF and APRIL, significantly reduced proteinuria in the phase 3 ORIGIN trial. At week 36, proteinuria fell substantially more with atacicept than with placebo (approximately 42% greater reduction versus placebo). Rituximab did not reduce proteinuria or galactose-deficient IgA1 in a randomized IgAN trial. Hydroxychloroquine has limited population-specific data and is not a broadly established disease-modifying standard, while fish oil has inconsistent evidence. As of July 2026, atacicept-vymj (Trutakna) has also received FDA accelerated approval to reduce proteinuria in adults with primary IgAN at risk for disease progression.

Why each option

A.
Correct. Atacicept significantly reduced proteinuria versus placebo in the phase 3 ORIGIN trial.
B.
Incorrect. Rituximab failed to reduce proteinuria or Gd-IgA1 in a randomized IgAN trial.
C.
Incorrect. Hydroxychloroquine lacks robust phase 3 evidence in IgAN.
D.
Incorrect. Fish oil has mixed, inconclusive evidence and is not first-line.

Reference: Lafayette R, et al. Atacicept in IgA Nephropathy (ORIGIN), N Engl J Med. 2026; FDA accelerated approval of atacicept-vymj (Trutakna), July 7, 2026. Rituximab: Lafayette RA, et al. J Am Soc Nephrol. 2017;28:1306-1313.

This is one of 1,100 questions in the MedBoardSA nephrology bank, with timed test mode, tutor mode, and progress tracking by topic.

Practise the full bank

More Primary GN questions

Browse other topics