Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients With IgA Nephropathy

Abstract

The effect of glucocorticoids on major kidney outcomes and adverse events in IgA nephropathy has been uncertain. OBJECTIVE To evaluate the efficacy and adverse effects of methylprednisolone in patients with IgA nephropathy at high risk of kidney function decline.DESIGN, SETTING, AND PARTICIPANTS An international, multicenter, double-blind, randomized clinical trial that enrolled 503 participants with IgA nephropathy, proteinuria greater than or equal to 1 g per day, and estimated glomerular filtration rate (eGFR) of 20 to 120 mL/min/1.73 m 2 after at least 3 months of optimized background care from 67 centers in

Immunosuppression Exposure and Risk of Infection-Related Acute Care Events in Patients With Glomerular Disease: An Observational Cohort Study

“…These findings strongly support efforts to develop novel, and refine existing, treatment strategies that minimize or altogether forgo use of corticosteroids for patients with MCD, 21 FSGS, 22 MN, 23 and IgAN. 24 …”

Steroids for IgA Nephropathy: A #NephJC Editorial on the TESTING trial

“…This was a randomized, double-blind, placebo-controlled, multicenter trial. 7 A 12-week run-in period was utilized to optimize background therapy with renin angiotensin system blockade. Those who had persistent proteinuria and satisfied inclusion criteria (biopsy-proven IgAN, proteinuria >1 g/day, and eGFR 20-120 mL/min/1.73 m 2 ), despite treatment adherence, were randomized to receive either oral methylprednisolone or a matching placebo.…”

“… 6 The TESTING investigators studied use of a lower dose methylprednisolone to reduce its adverse effects and provide a more conclusive answer in this setting. 7 …”

Reduced‐dose steroid for Asians with Immunoglobulin A nephropathy at risk of progressive kidney disease may reduce metabolic complications

“…It was thus encouraging that the recently published findings of the Therapeutic Evaluation of STeroids in IgA Nephropathy Global study (TESTING) supported reduced-dose steroid for Asians with IgAN. In this trial that included 478 Asians (95% of the trial cohort) at risk of progressive disease, 7 reduced-dose oral methylprednisolone 0.4 mg/kg (equivalent to prednisolone 0.5 mg/kg) reduced the composite primary outcome of 40% decline in eGFR, kidney failure or death related to kidney disease compared to placebo. New-onset diabetes was rare in both the full-dose (0/136) and the reduced-dose (2/121, 1.6%) groups who received steroid.…”

“…New-onset diabetes was rare in both the full-dose (0/136) and the reduced-dose (2/121, 1.6%) groups who received steroid. While the presence and extent of cellular and fibrocellular crescents were not described, 7 TESTING excluded participants with crescents in >50% of the glomeruli. Further information from the prospectively defined sub-study that will evaluate the impact of histological features on steroid treatment response, particularly the efficacy of reduced-dose steroid in Asians with IgAN and crescents who are at-risk of progressive disease, will be useful to refine immunosuppression treatment in these individuals.…”