Supplementary materials: Matching-adjusted indirect comparison of kidney function in patients with immunoglobulin A nephropathy treated with nefecon or sparsentan

<p dir="ltr"><b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>Matching-adjusted indirect comparison of kidney function in patients with immunoglobulin A nephropathy treated with nefecon or sparsentan</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b></p><ul><li><b>Supplementary methods</b></li><li><b>Supplementary Table S1:</b> Patient baseline characteristics used for the MAICs.</li><li><b>Supplementary Table S2:</b> Input data for the network meta-analysis.</li><li><b>Supplementary Table S3:</b> Results from matching-adjustment for the unanchored MAIC.</li><li><b>Supplementary Table S4: </b>Results of the fixed-effects network meta-analysis.</li><li><b>Supplementary Figure S1:</b> Distribution of weights derived for the anchored MAIC.</li><li><b>Supplementary Figure S1:</b> Distribution of weights derived for the anchored MAIC.</li><li><b>Supplementary Figure S2:</b> Distribution of weights with nefecon <b>(A)</b> and placebo <b>(B)</b> in NefIgArd, derived for the unanchored MAIC.</li><li><b>Supplementary Figure S3:</b> Forest plot for the unanchored MAIC for eGFR <b>(A)</b>, UPCR <b>(B)</b>, and UACR <b>(C)</b> at different time points; forest plot for the unanchored MAIC for time to confirmed 40% eGFR reduction, ESKD, or all-cause mortality <b>(D)</b>.</li><li><b>Supplementary References</b></li></ul><p dir="ltr"><b>Aim:</b> We compared the effects of nefecon, an oral targeted-release budesonide formulation, and sparsentan, an oral, dual endothelin-angiotensin receptor antagonist, on estimated glomerular filtration rate (eGFR) in patients with immunoglobulin A nephropathy, a leading cause of chronic kidney disease. <b>Materials & methods:</b> We conducted an anchored matching-adjusted indirect comparison (MAIC) using patient-level data from NefIgArd (NCT03643965; n = 364), a randomized (1:1) trial of nefecon plus optimized renin–angiotensin system inhibitor (RASi) therapy versus placebo plus RASi; and aggregate data from PROTECT (NCT03762850; n = 404), a randomized (1:1) trial of sparsentan versus irbesartan, an angiotensin receptor blocker. Mean absolute eGFR change and mean relative urine protein-to-creatinine and urine albumin-to-creatinine ratio changes from baseline at 9, 12 and 24 months (NefIgArd) or 36, 48 and 106 weeks (PROTECT) were analyzed using amixed-effects model for repeated measures. A composite outcome (time to confirmed 40% eGFR reduction, end-stage kidney disease or all-cause mortality) was also included. An unanchored MAIC and network meta-analysis were used as sensitivity analyses. <b>Results: </b>The matching process reduced the effective sample for the NefIgArd trial from 364 to 208. Absolute eGFR change significantly favored nefecon over sparsentan at 9 months (mean difference,ml/min/1.73m2 [95% credible interval]: 5.7 [3.1–8.2]), 12 months (3.5 [1.0–6.0]) and 24 months (3.3 [0.0–6.5]). Differences in other outcomes were generally not statistically significant. Sensitivity analysis results were consistent with the main findings. <b>Conclusion:</b> In patients with immunoglobulin A nephropathy, nefecon plus optimized RASi may preserve kidney function to a greater extent than sparsentan.</p>