Bryce Barr

If my house is on fire, and my only option to put out the fire is to douse it in water, douse it in water. I dont like it but it’s the only disease modifying treatment available in many places (hopefully not for long). Also doesn’t need to be an “or”, I start the SGLT2 when I taper the pred. #NephJC

New insights into the biology and treatment of minimal... : Current Opinion in Nephrology and Hypertension sease and focal segmental glomerulosclerosis, there has been a transformation of our understanding of disease pathogenesis and treatment rationale. Recent findings Antinephrin antibodies are common...

It was a pleasure to collaborate with @kronbichlerlab.bsky.social and Dr. Astrid Weins on this article. We describe transformations in our understanding of podocytopathies, and novel treatment approaches in light of those advancements. journals.lww.com/co-nephrolhy...

Thanks Brendon. It’s something I wonder about given the proteinuria and eGFR curves in both TESTING and NefIgArd. And the MAIN trial for that matter, with its continuation vs withdrawal group. Data like that may help to inform what we do after someone completes a per-trial protocol treatment period

Really helpful insights Brendon.

I’m curious if the investigators have planned to analyze eGFR slope beginning after the treatment period? In particular, a single slope (no knot) with time zero at 9 months post-randomization to end of follow up? Would be helpful to evaluate the durability of GCs

I personally follow IgG levels every 3-6 months for patients on anti CD20 (at a minimum prior to the next dose of B cell depletion).

Impact of Glucocorticoid Dose on Complete Response, Serious Infections, and Mortality During the Initial Therapy of Lupus Nephritis: A Systematic Review and Meta-Analysis of the Control Arms of Random... A higher exposure to glucocorticoids during the initial therapy of LN was associated with better renal outcomes at the cost of increased infections and death.

Part of that could be the prednisone dosing. In LUNAR, started at 0.75mg/kg and tapered to <10mg/d at 16 weeks. Here started at 0.5mg/kg and tapered to <7.5mg/d at 12 weeks. Based on this meta analysis it makes sense that would increase infections. pubmed.ncbi.nlm.nih.gov/38766897/

Indigenous people in MB are probably overrepresented in our LN population based on our registry data, on a per capita basis

“Those nasty Canadians are ripping us off and are controlled by Mexican cartels. They’re poisoning us with fentanyl and need to become the 51st state or they will pay a high price” is a belief that literally ZERO Americans had six weeks ago. It’s entirely invented from scratch.

#askrenal Any tips for getting patients started on GLP-1 without debilitating nausea? Starting patients as per the FLOW protocol, counseling them that it could be temporary and to try to keep going, and I’ve only got a few still on treatment. What am I doing wrong? @hswapnil.medsky.social

I tell this to every single person! They’ve all heard of “anti-inflammatory diets,” etc and assume that if it’s possible to cure your AI disease as such, then the opposite behaviour gave them the AI disease. I see more relief when I tell people this than when I tell them they’re in remission.

Problem with RTX was it worked when it worked. But if not BCD, no increase in efficacy vs MMF alone. So this will be a more reliable alternative

I think that we’ve gained another tool that accomplishes both the goals of remission and steroid reduction. Extra renal dz drives up front choice IMO - none with nephrotic syndrome CNI, skin/joint BEL, really severe obi or CYC.

I think my preference would be to follow the trial protocol unless funding is a problem and I’m limited in the number of doses I can give

Only given obi a couple of times in PLA2R-MN, and both times the patient paid cash, so I gave one dose, checked CD19 at 4 weeks and both were CD19 =0, so no more. Both reached complete remission. In SLE the post hoc from LUNAR shows the importance of BCD, so I would follow every 3mo to 12mo I think

I should add that this trial extended beyond 12 months so gave 12 month doses which was not done in LUNAR, but the B cell depletion data at 12 months wouldn’t be affected by that.

It’s actually the mechanism of action - this is the same dosing schedule as LUNAR. NK cell function is reduced in SLE so ADCC with RTX is impaired. Fc region of obi is engineered to get around this problem. Only 50% had B cell depletion at 12 mo in LUNAR vs >90 here.

Need to factor in adherence, and presence/absence of extra-renal manifestations. CNI tough on adherence and minimal effect re extra renal disease. Obi is very attractive for that reason, and in my experience, even in severely proteinuric patients, one dose of obi = CD19 0. So could be cheaper.

Doesn’t that completely change the research question? If the exposure variables are clinical parameters, versus the disease itself?

Mexit

Me!

Feels like my first 🦋post should be about lupus, but it’s not too late to register for this CSN Webinar about IgA! I’ll be discussing the all of the recent data, interpreting new trial endpoints, and how to apply the available treatments in Canada through a practical lens! www.csncommunity.ca