Bryce Barr
@brycebarr.bsky.social
Nephrology/Glomerulonephritis at Health Sciences Centre, Winnipeg | Assistant Professor at UManitoba | Manitoba Glomerular Diseases Registry PI
I find it extremely odd that the first sentence identifies PJP prophylaxis as a major indication for TMP/SMX, and the rest of the paper seems to completely ignore that. No mention of autoimmune disease in the tables, or the 84 variables used to calculate the propensity score
November 25, 2025 at 2:58 AM
I find it extremely odd that the first sentence identifies PJP prophylaxis as a major indication for TMP/SMX, and the rest of the paper seems to completely ignore that. No mention of autoimmune disease in the tables, or the 84 variables used to calculate the propensity score
Certainly. I think that is a really important takeaway from this paper.
I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?
I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?
November 23, 2025 at 7:52 PM
Certainly. I think that is a really important takeaway from this paper.
I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?
I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?
Interesting, thanks for sharing. I’ll need to read more about this registry, because the age of the patients is not consistent with other studies in LN and GN at all. I’m a bit surprised that doesn’t get mentioned.
November 23, 2025 at 2:33 PM
Interesting, thanks for sharing. I’ll need to read more about this registry, because the age of the patients is not consistent with other studies in LN and GN at all. I’m a bit surprised that doesn’t get mentioned.
The field owes her a great debt of gratitude in my opinion. Her talk at the ASN two years ago about this journey was fascinating. #NephJC
November 19, 2025 at 3:03 AM
The field owes her a great debt of gratitude in my opinion. Her talk at the ASN two years ago about this journey was fascinating. #NephJC
I think the best we can hope for (unfortunately) is that sponsors continue to shrink the immunosuppression washout period. Currently, my practice is to treat with the immunosuppression I have available to me (GCs), and if they still have >1g/d, enrol in an RCT as soon as the trial allows.
November 19, 2025 at 2:46 AM
I think the best we can hope for (unfortunately) is that sponsors continue to shrink the immunosuppression washout period. Currently, my practice is to treat with the immunosuppression I have available to me (GCs), and if they still have >1g/d, enrol in an RCT as soon as the trial allows.
Yes, stable treatment effect, suggesting the benefit is additive.
November 19, 2025 at 2:42 AM
Yes, stable treatment effect, suggesting the benefit is additive.
Depending on the definition of recent, close race between Pitcher et al re: long term outcomes in IgAN and Watts et al re: the discovery of antibody-mediated podocytopathy (along with the confirmatory/supporting studies)
November 12, 2025 at 2:29 AM
Depending on the definition of recent, close race between Pitcher et al re: long term outcomes in IgAN and Watts et al re: the discovery of antibody-mediated podocytopathy (along with the confirmatory/supporting studies)
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
October 29, 2025 at 2:18 AM
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
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
March 20, 2025 at 1:08 AM
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’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
March 18, 2025 at 1:31 AM
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’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).
March 12, 2025 at 12:09 PM
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).
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/
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.
pubmed.ncbi.nlm.nih.gov
March 12, 2025 at 12:07 PM
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
March 12, 2025 at 11:58 AM
Indigenous people in MB are probably overrepresented in our LN population based on our registry data, on a per capita basis
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.
February 12, 2025 at 2:27 AM
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
February 12, 2025 at 1:54 AM
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.
February 12, 2025 at 1:54 AM
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
February 11, 2025 at 8:54 PM
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
February 11, 2025 at 8:53 PM
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.
February 8, 2025 at 4:43 PM
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.