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Four-Pillar Perioperative Medication Plan — ESENeph MCQ

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HardDiabetic Kidney DiseaseFour-Pillar Perioperative Medication PlanESENeph

A patient with primary IgA nephropathy starts sparsentan with UPCR 240 mg/mmol. At 36 weeks UPCR is 204 mg/mmol, a 15% reduction. What does NICE TA1074 require?

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Correct answer: A — Stop sparsentan under the NICE non-response rule applied at week 36

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

C is correct. NICE’s NHS stopping rule applies at 36 weeks when both conditions are met: UPCR remains at least 199 mg/mmol and has not fallen by 20% or more. A fall from 240 to 204 mg/mmol is 15%, so treatment stops. The rule is a commissioning condition rather than part of the marketing authorisation. Sparsentan already combines endothelin-A and angiotensin-receptor blockade, so adding an ACE inhibitor or ARB creates unsafe duplicate RAS blockade. Potassium, blood pressure, oedema, pregnancy prevention and liver tests remain relevant during treatment.

Reference: NICE TA1074: sparsentan for primary IgA nephropathy: https://www.nice.org.uk/guidance/ta1074/chapter/1-Recommendations