A course of oral steroids prevents major kidney events in high-risk IgA nephropathy

Reuters Health - 09/11/2021 - A course of oral methylprednisolone taken for six to nine months reduces the risk of major kidney events and kidney failure in patients with high-risk IgA nephropathy, according to results of a randomized controlled trial.

"IgA nephropathy is a common cause of kidney failure, particularly amongst young people, which has an immunological basis but for which there are no specific therapies that are clearly proven to be beneficial in preventing important kidney outcomes," study author Dr. Vlado Perkovic of the University of New South Wales, in Australia, explained during a press briefing highlighting "high-impact" clinical trials held during Kidney Week 2021.

The TESTING study evaluated the effects of oral methylprednisolone compared with placebo on major kidney outcomes in 503 patients with biopsy-proven IgA nephropathy at high risk (protenuria > 1 g/day). Patients were randomized to oral methylprednisolone (full or reduced doses) or matching placebo for two months, with tapering over about six months.

Over a mean follow-up of 4.2 years, methylprednisolone reduced the risk of the primary outcome (at least 40% drop in estimated glomerular filtration rate or kidney failure) by 47% and that of kidney failure by 41%.

The reduction in risk was seen with both full and reduced steroid doses "with no evidence that the magnitude of the benefit is reduced" with lower doses, Dr. Perkovic reported. Serious adverse events were more common with methylprednisolone than placebo, particularly with the full dose, compared with the reduced dose.

"This trial clearly demonstrates that oral steroids have a role in preventing kidney failure in the types of participants that were enrolled here and that a reduced dose regimen has a better safety profile," Dr. Perkovic told the briefing.

"A key question that comes up is generalizability. Three-quarters of the patients in this study were recruited from China and many people have asked whether those results are generalizable, but actually the results were slightly greater in people from other parts of the world, not from China, so I think this provides very strong evidence of benefit that will change guidelines and practice," he added.

SOURCE: https://bit.ly/3CUIO6m Kidney Week 2021, held November 4-7, 2021.

By Megan Brooks



Posted on 9 November, 202116 November, 2021