Long-term effects of methylprednisolone pulses and mycophenolate mofetil in IgA nephropathy patients at risk of progression

Roccatello, Dario; Rossi, Daniela; Marletto, Fabio; Naretto, Carla; Sciascia, Savino; Baldovino, Simone; Piras, Doloretta; Giachino, Osvaldo

doi:10.5301/jn.2011.8452

Cited by 22 publications

(20 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For corticosteroid plus MMF therapy studies, main analyses revealed better therapeutic effects in corticosteroid plus MMF group compared to corticosteroid plus other immunosuppressive agent group (CTX and LEF), including the remission rate and stable renal function. Our data were supported by previous studies [14, 36]. All the three RCTs were from Asians, so we made subgroup analysis by therapy regimen instead of human race.…”

Section: Discussionsupporting

confidence: 84%

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Jia

Zhou

et al. 2017

BMC Nephrol

View full text Add to dashboard Cite

BackgroundThe application of mycophenolate mofetil (MMF) in treating patients with immunoglobulin A nephropathy (IgAN) remains uncertain. This update meta-analysis was performed to re-evaluate the therapeutic potential of MMF in IgAN.MethodsArticles were obtained by searching the electronic databases without language restriction. Randomized controlled trials studying the role of MMF in treating IgAN were collected. The quality of included studies was critically evaluated. Data analyses were performed by using RevMan 5.3 software.ResultsA total of 297 articles were screened and eight articles were finally included. Among the eight randomized controlled trials, five and three were high quality and low quality, respectively. Both fixed-effect and random-effect model were used. Pooled results by combining all the eight studies suggested that IgAN patients in MMF group had a higher remission rate than that in control group. Compared to placebo or corticosteroid monotherapy, MMF monotherapy exerted a higher remission rate and side effect rate in both main analysis and subgroup analysis by human race. Compared to corticosteroid plus other immunosuppressive agent therapy, corticosteroid plus MMF therapy had a higher remission rate, lower serum creatinine doubling rate, progression to end-stage renal disease rate and side effects rate. Subgroup analysis by therapeutic regimen further confirmed these results between corticosteroid plus MMF therapy and corticosteroid plus cyclophosphamide therapy. Funnel-plot displayed a symmetrical figure, indicating no publication bias existed.ConclusionsMMF has the potential in treatment of IgAN, especially for Asians. The evidence currently available shows that MMF monotherapy has a more efficacy but higher side effects when compared to placebo or corticosteroid monotherapy in treatment of Asians with IgAN. While MMF combined with corticosteroid regimen has a more efficacy and lower side effects when compared with corticosteroid plus cyclophosphamide regimen.

show abstract

Section: Discussionsupporting

confidence: 84%

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Jia

Zhou

et al. 2017

BMC Nephrol

View full text Add to dashboard Cite

show abstract

“…Treatment-related side effects were observed in only 2 patients. Roccatello et al (17) obtained favorable results with a combined schedule of steroids and mycophenolate mofetil in a subset of IgAN patients. However, patient characteristics were not comparable with our population, since all of the patients had at least 10% florid crescents.…”

Section: Discussionmentioning

confidence: 99%

IgA nephropathy with severe chronic renal failure: a randomized controlled trial of corticosteroids and azathioprine

Pozzi¹,

Andrulli²,

Pani

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background: Therapeutic nihilism is common in IgA nephropathy (IgAN) and renal insufficiency. Methods: In a randomized controlled trial comparing steroids alone or combined with azathioprine in 253 IgAN patients, we used a separate randomization list for patients with creatinine >2.0 mg/dL. Twenty patients (group 1) were randomized to 3 intravenous pulses of methylprednisolone 1 g at months 1, 3 and 5, and oral prednisone 0.5 mg/kg every other day plus azathioprine 1.5 mg/kg/day for 6 months, followed by oral prednisone 0.2 mg/kg every other day plus azathioprine 50 mg/day for a further 6 months; 26 patients (group 2) received steroids alone. The primary outcome was renal survival (50% increase in plasma creatinine from baseline); secondary outcomes were proteinuria over time and adverse events. Results: Six-year renal survival was not different between the 2 groups (50% vs. 57%; log-rank p=0.34). Median proteinuria decreased during follow-up in the whole population (from 2.45 g/day [interquartile range (IQR) 1.50-3.78] to 1.09 g/day ]; p<0.001), with no between-group difference. Multivariate predictors associated with renal survival were sex of patient, proteinuria during follow-up, number of antihypertensive drugs, angiotensin-converting enzyme inhibitors and treatment including azathioprine. Six patients in group 1 (30%) and 4 in group 2 (15%) did not complete the therapy, because of side effects (p=0.406). Conclusions: Six-year renal survival was similar in the 2 groups. At Cox analysis the addition of azathioprine may be slightly more effective than corticosteroids alone in patients with chronic renal insufficiency, although with an increase of side effects.

show abstract

“…The treated patients experienced significantly better renal survival and a greater reduction in proteinuria levels than those in the control group. More recently, Roccatello et al [18] reported a case series of IgAN patients with acute inflammatory histologic changes (diffuse mesangial proliferation with at least 10% florid crescents), CKD (mean serum creatinine 1.6 mg/dL, range 1.2–2.9), and proteinuria (mean 2.4 g/day, range 1.13–5.25) who received a combined schedule of steroids and MMF. Following treatment, serum creatinine and proteinuria significantly dropped at 6 months compared with baseline values and remained lower during a mean follow up of 51 months (range 24–90).…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids in Patients with IgA Nephropathy and Severe Chronic Renal Damage

Pozzi

Ferrario

Visciano

et al. 2012

Case Reports in Nephrology

View full text Add to dashboard Cite

Little is known about the utility of treating patients with advanced IgA nephropathy (IgAN). From 2001 to 2005, four patients came to our observation because of serum creatinine higher than 3 mg/dL, proteinuria ranging from 1.8 to 5.1 g/day, and a histological picture of diffuse sclerotic lesions. A corticosteroid course of 12 months was given. Patients were observed for a mean follow up of 84 months. At the end of the steroid course, proteinuria lowered quickly below 1 g/day in two patients, whereas the other two experienced a slower and less persistent decrease of proteinuria. Despite similar lesion severity at renal biopsy, renal function stabilized only in these two ones. In conclusion, these preliminary observations suggest a possible efficacy of corticosteroids in slowing down the progression of renal disease and in postponing the need of dialysis in IgAN patients with stage IV CKD and severe chronic histological lesions.

show abstract

Long-term effects of methylprednisolone pulses and mycophenolate mofetil in IgA nephropathy patients at risk of progression

Cited by 22 publications

References 4 publications

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

IgA nephropathy with severe chronic renal failure: a randomized controlled trial of corticosteroids and azathioprine

Corticosteroids in Patients with IgA Nephropathy and Severe Chronic Renal Damage

Contact Info

Product

Resources

About