Abstract: SA-OR092
Long-Term Effect of Oral Methylprednisolone on Kidney Outcomes in Patients with IgAN: TESTING-ON, a Post-Trial Observational Study
Session Information
- Late-Breaking Research Orals - 3
November 08, 2025 | Location: Grand Ballroom C, Convention Center
Abstract Time: 05:18 PM - 05:30 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Wong, Muh Geot, The George Institute for Global Health, Sydney, New South Wales, Australia
- Lv, Jicheng, Peking University First Hospital Department of Nephrology, Beijing, China
- Bao, Yunfei, Peking University First Hospital Department of Nephrology, Beijing, China
- Anderson, Rebecca Js, The George Institute for Global Health, Sydney, New South Wales, Australia
- Kim, Dana, The George Institute for Global Health, Sydney, New South Wales, Australia
- Shan, Sana, The George Institute for Global Health, Sydney, New South Wales, Australia
- Hladunewich, Michelle A., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Jha, Vivekanand, The George Institute for Global Health India, New Delhi, DL, India
- Hooi, Lai Seong, Sultanah Aminah Hospital, Johor Bahru, Malaysia
- Monaghan, Helen, The George Institute for Global Health, Sydney, New South Wales, Australia
- Perkovic, Vlado, University of New South Wales, Sydney, New South Wales, Australia
- Zhang, Hong, Peking University First Hospital Department of Nephrology, Beijing, China
Group or Team Name
- TESTING Trial Steering Committee.
Background
The Therapeutic Evaluation of STeroids in IgA Nephropathy Global (TESTING) trial reported that full and reduced doses of oral methylprednisolone can reduce the risk of a composite kidney outcome and kidney failure. Therefore, it is unclear if a reduced dose corticosteroid regimen safely improves long-term kidney outcomes and if these benefits sustained over time. We report the findings from long-term post-trial follow-up aiming to understand whether the effects persist overall and by dose (TESTING-ON, NCT05434325).
Methods
We invited all surviving participants who had not reach kidney failure, previously assigned to full or reduced dose methylprednisolone or placebo, to participate in observational post-trial follow-up. The primary endpoint for this study was kidney failure or death due to kidney disease. Secondary outcomes included the composite of kidney failure, 30/40/50% decrease in eGFR and all cause death, as well as death due to kidney disease, annual eGFR decline, and time averaged proteinuria on 24-hour urine collection.
Results
Of 365 eligible participants, 211 (58%) consented to participate with median total follow up of 6.4 years (Q1 5.2, Q3 8.8). The baseline characteristics were comparable to those of the 503 participants who originally underwent randomization. Overall, 93 participants in the corticosteroid arm and 109 in the placebo arm reached the primary outcome (hazard ratio 0.66, 95% confidence interval, 0.50 to 0.88; P=0.0049). The treatment effect was consistent across most secondary outcomes and all protocol-specified subgroups. The reduction of time averaged proteinuria among those who received methylprednisolone was no longer evident whilst the between group differences in annual eGFR slope remained significant throughout the post-trial period.
Conclusion
The beneficial effect of oral methylprednisolone on kidney failure and related outcomes in individuals with high-risk IgA nephropathy persisted out to a median follow-up of 6.4 years.
Funding
- Government Support - Non-U.S.