IgA nephropathy has moved, in only a few years, from a disease with no approved therapy to one of the most crowded launch environments in nephrology. That speed is exactly what makes reimbursement the hard question: several novel classes have arrived almost together, each priced far above the inexpensive supportive care that remains the comparator payers know. This page brings together MARA’s independent assessments of the drugs in this space — each one dated, kept on the record, and replaced by a newer version when the evidence moves.
What payers ask in IgA nephropathy
Does proteinuria reduction earn reimbursement on its own?
Most recent approvals rest on proteinuria — a marker measured in the urine — under accelerated (early, conditional) approval pathways, while payers care about preserved kidney function and time to kidney failure. How each HTA body — the national agency that assesses what a drug is worth to the health system — treats that stand-in evidence at launch is the single most recurring driver of reimbursement risk in this disease.
What is the added value over optimised supportive care?
The standard kidney-protecting tablets — blood-pressure treatment, RAS inhibitors and, since 2026, generic dapagliflozin (the SGLT2 inhibitor with the kidney indication) — are inexpensive and improving on their own. Every new agent is measured against that moving, low-cost baseline.
Who exactly is the reimbursed patient?
Labels and payer criteria can diverge on proteinuria thresholds and risk of progression; the reimbursed population is often narrower than the studied one.
What does chronic use cost?
IgA nephropathy patients are often diagnosed young. Payers weigh years of therapy, possible sequencing of several novel agents, and unresolved questions about combinations.
The MARA record in IgA nephropathy
MARA has assessed the whole first wave of IgA nephropathy therapies — six drugs across three distinct mechanisms, all rated within a single year of each other. That makes this one of the few places where their reimbursement risk can be compared side by side, on the same standard, at comparable moments in their evidence. Each report answers the same set of payer questions, carries its “as of” date, and stays on the record: when the evidence moves, a new vintage replaces the old one, and both remain visible. Assessments are produced on MARA’s own initiative for awareness; the current MARA Rating for any drug is available on request.
Current assessments
- TRUTAKNA / atacicept-vymj for Primary IgA Nephropathy as of August 2026
- Povetacicept (alpn-303) for treatment of primary IgA nephropathy as of April 2026
- Vanrafia / atrasentan for reducing proteinuria in primary IgA nephropathy as of February 2026
- Sibeprenlimab-szsi / voyxact for reducing proteinuria in adults with primary IgA nephropathy as of February 2026
- Sparsentan for treating primary IgA nephropathy as of October 2025
- Kinpeygo / budesonide for treating primary IgA nephropathy as of October 2025
Selected commentary
For how a MARA Rating is built, see the methodology and what a MARA Rating is. To request the current rating for any drug in this disease, use the contact form.
Independent MARA Rating assessments of reimbursement risk in IgA nephropathy: sparsentan, budesonide, atrasentan, sibeprenlimab, povetacicept, atacicept.