Delivery 7–10 daysFilspari (sparsentan) 400 mg tablets
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Description
💊 Prescription dual endothelin and angiotensin II receptor antagonist for primary IgA nephropathy in adults at risk of rapid progression.
▪︎ Sparsentan 400 mg film-coated tablets, 30 per bottle
▪︎ Manufacturer: Travere Therapeutics
▪︎ FDA: accelerated approval February 2023 on proteinuria, full approval September 2024 on kidney function
🔬 How it works: kidney protection has long rested on suppressing angiotensin, which lowers pressure inside the glomerulus. But a second route of damage runs through endothelin, the most powerful vasoconstrictor peptide known, which directly injures podocytes — the cells of the kidney filter. Sparsentan closes both routes with one molecule: one part binds the angiotensin II type 1 receptor, the other the endothelin A receptor. 📊 Evidence: PROTECT (Lancet 2023) in 404 patients with IgA nephropathy — urine protein 40% lower than on irbesartan at week 110, and eGFR declining at −2.7 versus −3.8 mL/min/1.73 m² per year (p=0.037). In DUPLEX (NEJM 2023), in focal segmental glomerulosclerosis, proteinuria fell as well but no difference in eGFR slope appeared at week 108 — which is why there is no FSGS indication.
⚠️ Prescription-only, started by a nephrologist after biopsy. In the US it is dispensed under a restricted REMS programme because of hepatotoxicity and embryo-fetal toxicity: liver enzymes are monitored and pregnancy must be excluded. Never combined with ACE inhibitors, ARBs or other endothelin antagonists — the previous agent is stopped, not stacked.
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