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Abstract: PO1981

Efficacy of New Combination Therapy with Prednisolone, Mizoribine, and Lisinopril for Severe Childhood IgA Nephropathy

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Shima, Yuko, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Mukaiyama, Hironobu, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Tanaka, Yu, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Wada, Takuzo, Wakayama Kenritsu Ika Daigaku, Wakayama, Wakayama, Japan
  • Kaito, Hiroshi, Hyogo Kenritsu Kodomo Byoin, Kobe, Hyogo, Japan
  • Tanaka, Ryojiro, Hyogo Kenritsu Kodomo Byoin, Kobe, Hyogo, Japan
  • Nozu, Kandai, Kobe Daigaku, Kobe, Hyogo, Japan
  • Iijima, Kazumoto, Kobe Daigaku, Kobe, Hyogo, Japan
  • Yoshikawa, Norishige, Shakai Iryo Hojin Aijinkai Takatsuki Byoin, Takatsuki, Osaka, Japan
  • Nakanishi, Koichi, Ryukyu Daigaku, Nakagami-gun, Okinawa, Japan
Background

Our previous RCT shows that warfarin and dipyridamole added to prednisolone (PSL) and mizoribine (MZB) in the 2-year combination therapy have additional effect for proteinuria remission in severe (diffuse mesangial proliferation, WHO) childhood IgAN compared to that with only PSL and MZB (Pediatr Nephrol 2018;33:2103-12). However, we have to consider avoiding the use of warfarin and dipyridamole due to side effects. Meanwhile, angiotensin-converting enzyme inhibitors such as lisinopril have been widely used for childhood IgAN since the 2000s. Therefore, we intended to examine the effect of new combination therapy including PSL, MZB, and lisinopril.

Methods

This cohort study included 84 patients with severe IgAN enrolled among 546 pediatric IgAN between 1977 and 2017, and divided into 2 groups, 70 patients treated with the previous combination therapy and 14 patients with the new combination therapy. A 1:1 propensity score matching was performed to account for between-group differences and 12 matched pairs were obtained.

Results

Proteinuria remission was significantly more obtained in the new treatment group (100% vs 50.0%, p=0.001). The patients with the new treatment achieved significantly faster proteinuria remission (median 2.4 vs. 12.0 months, p=0.04). The median duration of PSL use was significantly shorter in the new treatment group (13 vs. 24 months, p<0.0001). The median observation period was 4.9 and 4.5 years, and the percentage of patients with normal urine at the latest observation was significantly higher in the new group (66.7% vs. 25.0%, p=0.04).

Conclusion

Our findings suggest the usefulness of the new combination therapy with PSL, MZB, and lisinopril for severe childhood IgAN in achieving early proteinuria remission and shortening PSL use. Further investigations with the larger-scale and long-term outcome will be needed.