Low-Dose Corticosteroid Combined With Mycophenolate Mofetil for IgA Nephropathy With Stage 3 or 4 CKD: A Retrospective Cohort Study.

Abstract

PURPOSE\nThis study assessed the long-term (10-year) tolerability and efficacy of a low-dose corticosteroid combined with mycophenolate mofetil (CS\xa0+\xa0MMF) in the treatment of immunoglobulin A nephropathy (IgAN) with stage 3/4 chronic kidney disease and proteinuria in clinical practice in China.\n\n\nMETHODS\nData from patients with biopsy-proven IgAN, stage 3/4 chronic kidney disease (estimated glomerular filtration rate 15-59 mL/min/1.73 m2), and proteinuria (urinary protein excretion ≥1.0 g/d) and who were treated with uncontrolled supportive care (USC), CS, or CS\xa0+\xa0MMF between January 2008 and December 2017 were included. The primary end point was the prevalence of the composite outcome of any of the following conditions: a reduction in estimated glomerular filtration rate of ≥50%, end-stage renal disease, and death.\n\n\nFINDINGS\nOf the 120 enrolled patients, 44, 25, and 51 were treated with USC, CS, and CS\xa0+\xa0MMF, respectively. The median follow-up time was 40.1 months (IQR, 29.1-67.8 months). The prevalences of the composite outcome were 63.6%, 56.0%, and 19.6%, respectively (P < 0.001). The cumulative 5-year renal function-preservation rates were 48.1%, 51.4%, and 83.7%. After adjustment for covariates, the prevalence of the composite outcome was significantly decreased with CS\xa0+\xa0MMF (HR\xa0=\xa00.094; 95% CI, 0.026-0.335; P < 0.001), but not with CS (HR\xa0=\xa00.749; 95% CI, 0.354-1.583; P\xa0=\xa00.449), compared with USC. However, 4 patients in the CS\xa0+\xa0MMF group died, of whom 3 had severe pneumonia.\n\n\nIMPLICATIONS\nCS\xa0+\xa0MMF may have more promising efficacy than USC or CS in renal-function preservation in patients with IgAN and chronic kidney disease in the Chinese population. However, attention should be paid to the increased risk for death due to severe pneumonia.