Glucocorticoid Therapy Has Little Benefit on IgA Nephropathy
The risks and benefits of immunosuppressive therapy in IgA Nephropathy (IgAN) are controversial. The KDIGO guidelines suggest that, after optimized supportive treatment for 3 to 6 months, IgAN patients with >1 g/d proteinuria and eGFR>50 ml/min/1.73m2 are treated with high-dose glucocorticoid for 6 months. But the level of evidence for the recommendation is low.
The results of STOP-IgAN test were reported by Dr. Jyurgen Floege from the Department of Kidney Disease and Clinical Immunology, Aachen University, Germany, in 2015. In STOP-IgAN study, 162 IgAN patients with proteinuria > 0.75 g/d and high risk of progression after 6 months of optimal support therapy were randomly divided into the following two groups: continued supportive treatment or additional immunosuppressive therapy (Patients with eGFR >= 60 ml/min/1.73m2 were treated with glucocorticoid monotherapy for 6 months; patients with GFR of 30-59 ml/min/1.73m2 were treated with cyclophosphamide treatment followed by oral azathioprine and prednisone treatment for 3 months).
The main endpoints of STOP-IgAN were complete remission and loss of GFR >= 15 ml/min/1.73 m2 during a three-year trial. Finally, the study found that patients receiving immunosuppressive therapy were more likely to achieve complete clinical remission during the three-year follow-up period, but the annual loss rate of renal function was similar to that of the support group, and the adverse effects were more.
This study was a second intention-to-treat analysis conducted by Dr. Jyurgen Floege et al. in which the data of renal endpoint events in two subgroups of immunosuppressive therapy and those in the supportive treatment group were analyzed respectively. The article was published in JASN magazine in December 2017.
In the high eGFR group, the clinical complete remission rates of the support group and the glucocorticoid monotherapy group were 5.5% (3/54) and 20% (11/55) respectively (OR value 5.31, 95% CI 1.07-26.3, P = 0.02). In the low eGFR group, the complete remission rates of the support group and the combined immunosuppressive group were 3.8% (1/26) and 11.1% (3/27), respectively. There was no significant difference between the two groups (P = 0.30).
There was no significant difference in the endpoint event rate of GFR loss >= 15 ml/min/1.73 m2 between high and low eGFR groups. In the high eGFR group, 29.6% (16/54) and 21.8% (12/55) of the patients in the support group and the glucocorticoid monotherapy group reached this end point (P = 0.32). In the low eGFR group, 23.1% (6/26) and 30% (9/27) of the patients in the support group and the combined immunosuppressive group reached this end point (P = 0.42).
Only the glucocorticoid monotherapy group temporarily decreased the level of proteinuria at 12 months compared with the supportive treatment group (0.50+0.52:0.79+0.74 g/g, P = 0.01), but there was no difference between the two groups at the end of the study (0.57+0.53:0.80+0.64 g/g, P = 0.26).
The incidence of adverse events, such as severe infection, impaired glucose tolerance and/or weight gain, was higher in the two immunosuppressive groups than in the support group.
This study confirmed that only glucocorticoid monotherapy resulted in remission in a small number of IgAN patients with relatively good GFR but persistent proteinuria. No immunosuppressive therapy can prevent the decrease of eGFR and is associated with many adverse events. Therefore, the potential benefits of glucocorticoid monotherapy (reduced proteinuria) in patients with IgAN with good renal function need to be balanced against the increased risk of adverse events. It is also necessary to find alternative treatment for IgAN.
Since glucocorticoid therapy has little benefit on IgA Nephropathy, you can try Chinese medicine, which can help repair kidney damage and promote renal function. For more information on IgA Nephropathy treatment, please leave a message below or contact online doctor.
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