Immunosuppression versus Supportive Care on Kidney Outcomes in IgA Nephropathy in the Real-World Setting

作者：Zhao, Hao; Li, Yang; Sun, Jingdi; Xu, Gang; Wang, Cheng; Zhou, Shiyu; Nie, Sheng; Li, Yanqin; Su, Licong; Chen, Ruixuan; Cao, Yue; Gao, Qi; Hu, Ying; Li, Hua; Yang, Qiongqiong; Wan, Qijun; Liu, Bicheng; Xu, Hong; Li, Guisen; Weng, Jianping; Chen, Chunbo; Liu, Huafeng; Shi, Yongjun; Zha, Yan; Kong, Yaozhong; Su, Guobin; Tang, Ying; Zhou, Yilun; Guo, Aixin; Gong, Mengchun; Xu, Xin^*; Hou, Fan Fan^*

来源：Clinical Journal of the American Society of Nephrology, 2023, 18(9): 1186-1194.

DOI：10.2215/CJN.0000000000000215

• chronic GN
• chronic kidney failure
• ESKD
• IgA nephropathy
• immunosuppression
• outcomes

BackgroundThe efficacy of immunosuppression in the management of immunoglobulin A (IgA) nephropathy remains highly controversial. The study was conducted to assess the effect of immunosuppression, compared with supportive care, in the real-world setting of IgA nephropathy.MethodsA cohort of 3946 patients with IgA nephropathy, including 1973 new users of immunosuppressive agents and 1973 propensity score-matched recipients of supportive care, in a nationwide register data from January 2019 to May 2022 in China was analyzed. The primary outcome was a composite of 40% eGFR decrease of the baseline, kidney failure, and all-cause mortality. A Cox proportional hazard model was used to estimate the effects of immunosuppression on the composite outcomes and its components in the propensity score-matched cohort.ResultsAmong 3946 individuals (mean [SD] age 36 [10] years, mean [SD] eGFR 85 [28] ml/min per 1.73 m2, and mean [SD] proteinuria 1.4 [1.7] g/24 hours), 396 primary composite outcome events were observed, of which 156 (8%) were in the immunosuppression group and 240 (12%) in the supportive care group. Compared with supportive care, immunosuppression treatment was associated with 40% lower risk of the primary outcome events (adjusted hazard ratio, 0.60; 95% confidence interval, 0.48 to 0.75). Comparable effect size was observed for glucocorticoid monotherapy and mycophenolate mofetil alone. In the prespecified subgroup analysis, the treatment effects of immunosuppression were consistent across ages, sexes, levels of proteinuria, and values of eGFR at baseline. Serious adverse events were more frequent in the immunosuppression group compared with the supportive care group.ConclusionsImmunosuppressive therapy, compared with supportive care, was associated with a 40% lower risk of clinically important kidney outcomes in patients with IgA nephropathy.

• 单位
  复旦大学; 浙江大学; 南方医科大学; 电子科技大学; 广东省人民医院; 贵州大学; 中山大学; 广州中医药大学; 佛山市第一人民医院; 华中科技大学; 广东医学院