ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1636

The Potential Role of Monthly Corticosteroid Pulse in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kobayashi, Arisa, Japanese Red Cross Ashikaga Hospital., Ashikaga, Tochigi, Japan
  • Hirano, Keita, Japanese Red Cross Ashikaga Hospital., Ashikaga, Tochigi, Japan
  • Tsuboi, Nobuo, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • Yokoo, Takashi, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
Background

The risk of corticosteroid therapy may be underestimated in IgA nephropathy (IgAN). Previous studies provided that a fifth part of patients was older than 60 years and the rate of diabetes mellitus (DM) was increased in IgAN. The novel corticosteroid therapies with not losing benefit and reduced risk of corticosteroid are desired. Here, we aimed to determine whether monthly corticosteroid pulse is non-inferior in proteinuria remission and superior in blood glucose control to standard corticosteroid therapy or not.

Methods

Design: Retrospective, non-inferiority study.
Participants: Adult patients with IgAN received intervention described below between 2013 and 2020.
Intervention: Monthly corticosteroid pulse alone for 6 months versus standard corticosteroid therapy having oral corticosteroid for 6 months and three times of pulse corticosteroid in the same 6 months (Lancet 1999).
Outcomes: The primary outcome was proteinuria remission (<0.3g/day) at 1 year and we prespecified 0.67 in odds ratio (OR) as non-inferiority margin. The secondary outcome was safety of blood glucose care, which was defined by less than 0.3 in change of hemoglobin A1c% between baseline and 6 months.

Results

The enrolled 83 patients (22 patients >60 years old and 11 patients with DM) showed median proteinuria 0.93g/day and mean eGFR 60.5ml/min at baseline. There was no significant difference in proteinuria remission between the two groups but including the non-inferiority margin (16/21[76.2%] versus 38/62[61.3%], adjusted OR 4.10, 95%CI 0.47 to 36.1). The safety of blood glucose care in monthly corticosteroid pulse group was significantly superior to that in standard group (19/21[90.5%] versus 35/62[56.5%], adjusted OR 14.2, 95%CI 2.02 to 98.9).

Conclusion

Compared to standard corticosteroid therapy, the current study showed that monthly corticosteroid pulse did not reach the statistical requirements for a proven non-inferiority on proteinuria remission, but significantly exhibited safety outcome in the control of blood glucose. Prospective larger studies are needed to determine the role of monthly corticosteroid pulse in IgAN.