Clinical efficacy and safety of full-dose versus half-dose corticosteroids plus leflunomide for IgA nephropathy

Abstract

Background The results of leflunomide (LEF) in patients with IgA nephropathy (IgAN) were inconsistent. Methods A total of 149 kidney biopsy-confirmed IgAN patients with an estimated glomerular filtration rate (eGFR) ≥ 50 ml/min/1.73 m2 and protein excretion levels ≥0.75 g/d were enrolled, with 65 subjects receiving half-dose CS plus LEF (LEF group), and the 84 counterpart patients accepting full-dose corticosteroid (Full CS group). The primary outcomes included the complete remission (CR) rates and incidence of adverse events (AEs). The secondary outcomes were the overall remission (OR) rates and a combined event (eGFR reduced ≥30%, end-stage renal disease [ESRD], hemodialysis, peritoneal dialysis or kidney transplantation). Results During the 18 months of follow-up, the CR rates were 72 and 64% in the LEF and Full CS groups (P = 0.299), respectively. The proportion of patients with OR rates in the LEF group and Full CS group was 89% versus 75%, respectively (P = 0.027). Serious AEs were observed only in the Full CS group (P = 0.017). The incidences of total AEs (P = 0.036) and infections (P = 0.024) were lower in the LEF group than in the Full CS group. Conclusions LEF combined with half-dose CS is superior to full-dose CS in the treatment of IgAN.

Efficacy and safety of low-dose corticosteroids combined with leflunomide for progressive IgA nephropathy: a systematic review and meta-analysis

“…In addition, two articles were excluded because the full text was unavailable. Ultimately, three studies were included in our meta-analysis [ 22 – 24 ], with two RCTs [ 22 , 23 ]. Table 2 summarises the patient characteristics of the three studies.…”

“…Patients aged 18–65 years were included if they had proteinuria ≥ 1.0 g/24 h and an estimated glomerular filtration rate (eGFR) ≥ 30 ml/ min/1.73m 2 (calculated by CKD-EPI equation). Li Yebei et al (2021) [ 24 ] China retrospective cohort study low-dose corticosteroid plus leflunomide full-dose corticosteroid 65 84 LEF group: LEF, 50 (3d) -- 20 (6 m); CS, 0.4 ~ 0.6 mg/kg/day (2 m) -- 0.32 ~ 0.48 mg/kg/day (4 m). CS group: CS, 0.8 ~ 1 mg/kg/day (2 m) -- 0.64 ~ 0.8 mg/kg/day (4 m).…”