Immunosuppression versus Supportive Care on Kidney Outcomes in IgA Nephropathy in the Real-World Setting
Copyright © 2023 by the American Society of Nephrology..
BACKGROUND: The 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.
METHODS: A 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.
RESULTS: Among 3946 individuals (mean [SD] age 36 [10] years, mean [SD] eGFR 85 [28] ml/min per 1.73 m 2 , 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.
CONCLUSIONS: Immunosuppressive therapy, compared with supportive care, was associated with a 40% lower risk of clinically important kidney outcomes in patients with IgA nephropathy.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2023 Sep 1;18(9):1113-1115. - PMID 37533148 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 18(2023), 9 vom: 01. Sept., Seite 1186-1194 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhao, Hao [VerfasserIn] |
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| Links: |
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| Themen: |
Immunosuppressive Agents |
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| Anmerkungen: |
Date Completed 11.09.2023 Date Revised 12.10.2023 published: Print-Electronic CommentIn: Clin J Am Soc Nephrol. 2023 Sep 1;18(9):1113-1115. - PMID 37533148 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.0000000000000215 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Immunosuppression versus Supportive Care on Kidney Outcomes in IgA Nephropathy in the Real-World Setting |
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| 500 | |a Date Revised 12.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2023 Sep 1;18(9):1113-1115. - PMID 37533148 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND: The 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 | ||
| 520 | |a METHODS: A 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 | ||
| 520 | |a RESULTS: Among 3946 individuals (mean [SD] age 36 [10] years, mean [SD] eGFR 85 [28] ml/min per 1.73 m 2 , 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 | ||
| 520 | |a CONCLUSIONS: Immunosuppressive therapy, compared with supportive care, was associated with a 40% lower risk of clinically important kidney outcomes in patients with IgA nephropathy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 700 | 1 | |a Wang, Cheng |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Shiyu |e verfasserin |4 aut | |
| 700 | 1 | |a Nie, Sheng |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Yanqin |e verfasserin |4 aut | |
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| 700 | 1 | |a Shi, Yongjun |e verfasserin |4 aut | |
| 700 | 1 | |a Zha, Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Kong, Yaozhong |e verfasserin |4 aut | |
| 700 | 1 | |a Su, Guobin |e verfasserin |4 aut | |
| 700 | 1 | |a Tang, Ying |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Yilun |e verfasserin |4 aut | |
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| 700 | 1 | |a Gong, Mengchun |e verfasserin |4 aut | |
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