Abstract: FR-PO0855
Development and Validation of a Net Benefit Score to Guide Corticosteroid Therapy in IgAN
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Hirano, Keita, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Kitamura, Kento, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Sasaki, Takaya, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Okabe, Masahiro, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Yokote, Shinya, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Koike, Kentaro, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Shimizu, Akihiro, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Ueda, Hiroyuki, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Tsuboi, Nobuo, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Matsuzaki, Keiichi, Kitasato University, Sagamihara, Kanagawa, Japan
- Yasuda, Yoshinari, Gifu University, Gifu, Japan
- Yasuda, Takashi, Naruse Kidney Clinic, Machida, Tokyo, Japan
- Maruyama, Shoichi, Nagoya University, Nagoya, Aichi, Japan
- Shimizu, Akira, Nippon Medical School, Bunkyou, Tokyo, Japan
- Kawamura, Tetsuya, The Jikei University School of Medicine, Minato, Tokyo, Japan
- Suzuki, Yusuke, Juntendo University Faculty of Medicine, Bunkyou, Tokyo, Japan
- Yokoo, Takashi, The Jikei University School of Medicine, Minato, Tokyo, Japan
Background
Systemic corticosteroids remain widely used for IgA nephropathy (IgAN), yet their benefit–harm balance is uncertain. Although existing prognostic tools estimate renal risk, none incorporate treatment–related toxicity, leaving a critical gap in individualized decision–making. A model that integrates predicted renal benefit with adverse event risk could support more precise corticosteroid treatment decisions.
Methods
Two nationwide Japanese cohorts of biopsy–proven IgAN (n=2006) were combined and randomly split 3:1 into derivation (n=1504) and validation (n=502) cohorts. Corticosteroid exposure within one year of biopsy was categorized as pulse–based corticosteroids, non–pulse oral corticosteroids, or no corticosteroids. Renal function decline (≥50% increase in serum creatinine or initiation of renal replacement therapy) was modeled using Cox regression (Kidney model), and AE risk using negative binomial regression (AE model). A Net Benefit Score (NBS) was defined as renal benefit minus half the AE harm. Discrimination, calibration, and decision curve analysis (DCA) were evaluated.
Results
In the derivation cohort (mean age 39.2±16.2 years), renal function decline occurred in 163 patients (10.8%) and 132 AEs occurred among 105 patients (7.0%). Lower eGFR and higher proteinuria predicted renal function decline, while both pulse–based and non–pulse oral corticosteroids were associated with reduced risk. Older age and non–pulse oral corticosteroids predicted higher AE risk. Discrimination was strong (Kidney model C–statistic 0.85; AE model precision–recall area under the curve [PR–AUC] 0.18). Validation performance remained robust (C–statistic 0.81; PR–AUC 0.22). Calibration was adequate in both cohorts. DCA using the NBS consistently supported favorable net clinical benefit for pulse–based corticosteroids.
Conclusion
This integrated model quantifies renal benefit and AE risk, offering a practical framework to individualize corticosteroid therapy in IgAN. The NBS may help identify patients most likely to achieve net clinical benefit.
Acknowledgment
We thank all study participants, clinicians, primary investigators, coinvestigators, research personnel, and study teams involved in J–IGACS and JNR–IgAN.
Funding
- Government Support – Non-U.S.