Combined Immunosuppressive Treatment May Improve Short-Term Renal Outcomes in Chinese Patients with Advanced IgA Nephropathy

Abstract

Background/Aims: Treatment of advanced Immunoglobulin A nephropathy (IgAN) patients with estimated glomerular filtration rate (eGFR) below 45 mL/min per 1.73 m² remains inconsistent. The aim of this study is to compare the effects of corticosteroid and immunosuppressant therapies among these patients. Methods: A total of 201 adult patients with advanced IgAN (eGFR < 45 mL/min/1.73 m² and proteinuria > 1 g/24h at biopsy) grouped into supportive care (SC), steroids alone (CS), and steroids plus immunosuppressant (IT) groups, were investigated between 30^th December 2002 and 30^th June 2016. The primary endpoint was the combined endpoint of a 50% decline in eGFR and/or end stage renal disease (ESRD: eGFR < 15 mL/min/1.73 m² or maintenance renal replacement treatment). Responses to therapy included complete remission (CR: urinary protein excretion < 0.5 g/24h, with eGFR decrease less than 10% baseline), partial remission (PR: proteinuria decrease by > 50% baseline, with eGFR decrease less than 10% baseline), no response (NR: proteinuria decrease < 50% baseline, or eGFR decrease > 10% baseline) and ESRD. Kaplan–Meier and Cox proportional hazards analyses were performed. Results: During the follow-up period (37.2 ± 22.7 months), 6.8% patients in SC group, 25.0% in CS group, and 38.0% in IT group achieved CR or PR, while 78.4%, 62.5% and 49.3% patients in these 3 groups reached primary endpoint respectively (p < 0.001). Three-year renal survival rates in SC and combined immunosuppressive treatment groups (CS and IT groups) were 33.8% vs 51.2% (p = 0.02), and 5-year renal survival rates were 12.2% vs 21.3% (p = 0.1) respectively. Multivariate Cox regression analysis showed that hypertension (HR = 2.44, 95% CI 1.51–3.95; p < 0.001), Scr (HR = 1.01, 95% CI 1.00-1.01; p < 0.001), T1-T2 lesion (HR = 1.99, 95% CI 1.35–2.93; p = 0.001) were independent indicators of poor renal outcome. Conclusion: Immunosuppressive treatment (CS and IT therapy) may improve short-term renal outcome compared with supportive treatment in advanced IgAN patients.

Crescents and Global Glomerulosclerosis in Chinese IgA Nephropathy Patients: A Five-Year Follow-Up

“…In the current cohort, we found that more patients in C2 group received immunosuppressant than patients in C1 and C0 groups. Moreover, aggressive treatment contain immunosuppressant could effectively improve the renal outcome of IgAN patients (especially patients with crescents), which is similar to several other studies [12, 13]. Inconsistent with previous reports [10], C1 did not independently predict renal outcome in our cohort, and treatment responses were similar in patients in C1 and C0 groups.…”

Corticosteroids Improve Renal Survival: A Retrospective Analysis From Chinese Patients With Early-Stage IgA Nephropathy

“…In the Cox multivariate analysis, it was found that hypertension, Scr level, endocapillary hypercellularity, and tubular atrophy/interstitial fibrosis were significant independent predictors of poor renal outcome. These results are similar to previous reports (12,16). Although several reports (17) have shown that patients with cellular or fibrocellular crescents have worse prognoses, crescents were not found to be associated with renal survival in the current study.…”

“…However, the use of immunosuppressant drugs for IgAN is in dispute due to the difficulty in balancing between toxicity and long-term renal survival (11). Some reports found that immunosuppressants might lower proteinuria and improve renal outcome in patients with IgAN (12,13), while several studies did not find prominent benefits from an immunosuppressive combination protocol (14,15). Our study indicated that renal survival was significantly better in the CS group than in the IT group during the follow-up period.…”

The efficacy and safety of immunosuppressive therapies in the treatment of IgA nephropathy: A network meta-analysis

“…Notably, in the STOP-IgAN cohort, 1 out of 55 patients in the steroid monotherapy group and 5 out of 54 patients in supportive care group progressed to ESRD, demonstrating a slight trend for steroids being superior to supportive care, although there was no statistical significance, which might have resulted from the relatively small number of patients. Moreover, some retrospective studies have reported that immunosuppression is effective for treating IgAN 34,35 . Therefore, we believe that the addition of steroids to supportive care is beneficial to patients with IgAN.…”