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A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study.
Sci Rep. 2018 09 12; 8(1):13662.SR

Abstract

To compare the long-term efficacy of corticosteroids (P) alone or in combination with cyclophosphamide (CTX), leflunomide (LEF), or Angiotensin-convertase inhibitors or angiotensin II receptor blockers (ACEI/ARB) in treatment for IgA nephropathy (IgAN), 311 patients with IgAN were identified. Therapeutic effectiveness (including progression, partial remission, complete remission) and combined renal endpoint (defined as 30% reduction in eGFR or ESRD) were compared based on different therapies. After immunosuppressive and ACEI/ARB treatment, the levels of eGFR, proteinuria and albumin were significantly improved at the last follow-up, the extent of improvement of eGFR, proteinuria, and albumin was more notable in P + CTX group and P + LEF group. 41%, 52.2%, 55.3% and 55.2% in P + CTX, P + LEF, P and ACEI/ARB group achieved complete remission, respectively. Multivariate regression analysis indicated that only proteinuria (Relative risk (RR) 0.82(0.72-0.94), P = 0.004) and tubular atrophy/interstitial fibrosis (RR 0.26(0.13-0.57), P = 0.001) were predictors for complete remission. The optimal cutoffs of eGFR was 47.085 ml/min/1.73 m2 predicting renal function recovery in P + CTX therapy. In conclusion, tubular atrophy/interstitial fibrosis and massive proteinuria were poor predictors for complete remission in IgAN, it appears as though patients may have benefited from immunosuppressive treatment but that comparison to a well-matched contemporary control group or, ideally, a randomized controlled clinical trial, would be required to show this.

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Authors+Show Affiliations

Chen S
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.
Yin Q
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.
Ren S
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.
Zhong X
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.
Wang W
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.
Li G
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China. guisenli@163.com.
Wang L
Renal Division and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School of University of Electronic Science and Technology of China, Chengdu, 610072, China.

MeSH

Adrenal Cortex HormonesAdultAlbuminuriaAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsConservative TreatmentCyclophosphamideFemaleGlomerular Filtration RateGlomerulonephritis, IGAHumansImmunosuppression TherapyImmunosuppressive AgentsKidney TubulesLeflunomideMaleNephritis, InterstitialProteinuriaRetrospective StudiesTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30209279

Citation

Chen, Shasha, et al. "A Comparison of the Effectiveness of Cyclophosphamide, Leflunomide, Corticosteroids, or Conservative Management Alone in Patients With IgA Nephropathy: a Retrospective Observational Study." Scientific Reports, vol. 8, no. 1, 2018, p. 13662.
Chen S, Yin Q, Ren S, et al. A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018;8(1):13662.
Chen, S., Yin, Q., Ren, S., Zhong, X., Wang, W., Li, G., & Wang, L. (2018). A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Scientific Reports, 8(1), 13662. https://doi.org/10.1038/s41598-018-31727-5
Chen S, et al. A Comparison of the Effectiveness of Cyclophosphamide, Leflunomide, Corticosteroids, or Conservative Management Alone in Patients With IgA Nephropathy: a Retrospective Observational Study. Sci Rep. 2018 09 12;8(1):13662. PubMed PMID: 30209279.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. AU - Chen,Shasha, AU - Yin,Qing, AU - Ren,Song, AU - Zhong,Xiang, AU - Wang,Wei, AU - Li,Guisen, AU - Wang,Li, Y1 - 2018/09/12/ PY - 2017/07/12/received PY - 2018/08/06/accepted PY - 2018/9/14/entrez PY - 2018/9/14/pubmed PY - 2019/11/2/medline SP - 13662 EP - 13662 JF - Scientific reports JO - Sci Rep VL - 8 IS - 1 N2 - To compare the long-term efficacy of corticosteroids (P) alone or in combination with cyclophosphamide (CTX), leflunomide (LEF), or Angiotensin-convertase inhibitors or angiotensin II receptor blockers (ACEI/ARB) in treatment for IgA nephropathy (IgAN), 311 patients with IgAN were identified. Therapeutic effectiveness (including progression, partial remission, complete remission) and combined renal endpoint (defined as 30% reduction in eGFR or ESRD) were compared based on different therapies. After immunosuppressive and ACEI/ARB treatment, the levels of eGFR, proteinuria and albumin were significantly improved at the last follow-up, the extent of improvement of eGFR, proteinuria, and albumin was more notable in P + CTX group and P + LEF group. 41%, 52.2%, 55.3% and 55.2% in P + CTX, P + LEF, P and ACEI/ARB group achieved complete remission, respectively. Multivariate regression analysis indicated that only proteinuria (Relative risk (RR) 0.82(0.72-0.94), P = 0.004) and tubular atrophy/interstitial fibrosis (RR 0.26(0.13-0.57), P = 0.001) were predictors for complete remission. The optimal cutoffs of eGFR was 47.085 ml/min/1.73 m2 predicting renal function recovery in P + CTX therapy. In conclusion, tubular atrophy/interstitial fibrosis and massive proteinuria were poor predictors for complete remission in IgAN, it appears as though patients may have benefited from immunosuppressive treatment but that comparison to a well-matched contemporary control group or, ideally, a randomized controlled clinical trial, would be required to show this. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/30209279/A_comparison_of_the_effectiveness_of_cyclophosphamide_leflunomide_corticosteroids_or_conservative_management_alone_in_patients_with_IgA_nephropathy:_a_retrospective_observational_study_ DB - PRIME DP - Unbound Medicine ER -