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Sparsentan for treating primary IgA nephropathy

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1 Recommendations

1.1

Sparsentan should not be used to treat primary immunoglobulin A nephropathy (IgAN) in adults with a:

  • urine protein excretion of 1.0 g/day or more, or

  • urine protein-to-creatinine ratio of 0.75 g/g or more.

1.2

This recommendation is not intended to affect treatment with sparsentan that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Sparsentan is not required to be funded in the NHS in England to treat primary IgAN in adults with a urine protein excretion of 1.0 g/day or more, or a urine protein-to-creatinine ratio of 0.75 g/g or more. It should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that sparsentan offers value for money.

Why the committee made these recommendations

Standard care for primary IgAN includes angiotensin-converting enzyme inhibitors or angiotensin receptor blockers such as irbesartan. Sodium-glucose cotransporter-2 inhibitors are also often used.

Clinical trial evidence shows that sparsentan reduces the urine protein-to-creatinine ratio (the amount of protein in the urine) more than irbesartan. Evidence also suggests that sparsentan is better at maintaining kidney function than irbesartan, but this is uncertain.

There are uncertainties with some assumptions used in the economic model, including how sparsentan would be used in clinical practice.

Because of the uncertainties in the clinical evidence and economic model it is not possible to determine the most likely cost-effectiveness estimates for sparsentan. So, it should not be used.

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