Building a pathway to clinical trials in IgA vasculitis

IgA vasculitis (IgAV) is the most common form of vasculitis in children and, despite this, evidence-based treatment options for IgAV nephritis (IgAV-N) remain strikingly sparse. Cochrane reviews have repeatedly been unable to support evidence-based recommendations, and clinical practice varies widely as a result. That is now beginning to change.

In February 2025, 53 experts from 13 countries convened at Alder Hey Children’s NHS Foundation Trust in Liverpool for a multiprofessional international workshop focused on building a pathway to high-quality clinical trials in IgAV-N. The meeting proceedings have now been published in Kidney International Reports.

What the meeting agreed

The group reached consensus that adult and paediatric IgAV-N share sufficient pathophysiological similarity to support age-inclusive trial design – a significant step toward ending the fragmented, age-siloed approach that has hindered progress. Patients at greatest risk of kidney failure were identified as the priority population for initial trials, with active nephritis defined by proteinuria (with or without impaired kidney function or biopsy-proven inflammation) as the primary focus.

The group also recognised that IgAV-N shares important biological features with IgA nephropathy (IgAN), where a wealth of active trials is underway. Repositioning agents from the IgAN pipeline – particularly those targeting complement pathways and B-cell pathways – was felt to be a promising and achievable strategy. A multiarm platform trial design was favoured to evaluate multiple interventions efficiently within a single framework.

What comes next

The published proceedings mark the start, not the end, of this effort. A formal IgAV trial consortium will be established in September 2026, with an initial six-month mandate to maintain momentum and translate the meeting’s action points into trial-ready protocols.

Key workstreams include enriching observational data, developing and validating a disease-specific activity scoring tool, demonstrating biological similarity with IgAN to satisfy regulators, and building the patient and industry partnerships needed to make trials viable.

The meeting proceedings are open access in Kidney International Reports.