Abstract: SA-PO873
Immunosuppressive Agents for Treating IgA Nephropathy: An Updated Cochrane Review
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Palmer, Suetonia, University of Otago, Christchurch, New Zealand
- Ruospo, Marinella, Diaverum, Lund, Sweden
- Natale, Patrizia, Diaverum, Lund, Sweden
- Hegbrant, Jorgen BA, Diaverum, Lund, Sweden
- Strippoli, Giovanni F.M., Diaverum, Lund, Sweden
Background
IgA nephropathy (IgAN) is the most common glomerular disease worldwide. High certainty evidence for effective interventions has been impeded because due to the rarity of patient-centred endpoints such as end-stage kidney disease (ESKD) and heterogeneity in clinical progression and disease severity. As several recent trials have reported, we updated the Cochrane review evaluating the benefits and harms of immunosuppression for the treatment of IgAN.
Methods
A Cochrane systematic review with meta-analysis was updated to include randomized controlled trials in which adult and children with biopsy-proven IgA nephropathy were randomly allocated to immunosuppressive agent versus placebo, no treatment/standard care, or other non-immunosuppressive agent. Treatment effects were estimated by random-effects meta-analysis. Evidence certainty was adjudicated using GRADE methodology.
Results
54 studies (3730 patients) were included. Median follow-up was 24 months. Risk of bias was generally high or unclear. Steroid treatment probably prevents progression to ESKD (RR 0.41, 95% CI 0.26-0.65; moderate certainty evidence) and annual GFR loss (MD -5.40 ml/min/1.73m2, 95% CI -2.25 to -8.55; moderate certainty evidence), and may induce complete remission (RR 1.76, 95% CI 1.03-3.01; low certainty evidence). The addition of cytotoxic therapy to steroids had uncertain effects as did regimens containing mycophenolate mofetil (MMF), or calcineurin inhibitors as monotherapy on background steroid treatment. Adverse effects of treatment, especially infections, were uncertain due to a lack of data and heterogenous results in studies.
Conclusion
Steroid therapy probably prevents progression of ESKD and annual GFR loss and may induce complete remission. The effects of other treatments for treating IgA nephropathy were very uncertain and adverse events are poorly understood.