What is the efficacy of corticosteroids in the treatment of immunoglobulin A (IgA) nephropathy?

Updated: May 19, 2020
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

A retrospective study of 1147 patients from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort classified according to the Oxford-MEST classification (see Overview/Prognosis) showed a significant reduction in proteinuria, a slower rate of renal function decline, and greater renal survival with corticosteroid therapy. In contrast to KDIGO recommendations, corticosteroids reduced the risk of progression even in patients with an initial estimated GFR ≤50 mL/min/1.73 m2 and in direct proportion to the extent of proteinuria. Over median follow-up of 4.7 years, the annual decline in renal function with corticosteroid therapy versus no steroid use was 1.0 versus 3.2 mL/min/1.73 m2, respectively (= 0.004). [34]  

In contrast, the TESTING trial (Therapeutic Evaluation of STeroids in IgA Nephropathy Global study), which enrolled patients with proteinuria > 1 g/d and estimated GFR (eGFR) of 20 to 120 mL/min/1.73 m2, showed that high-dose oral methylprednisone was associated with significantly increased rates of serious adverse outcomes in participants with >1 g/day proteinuria. Patients were randomized 1:1 to oral methylprednisolone (0.6-0.8 mg/kg/d; maximum, 48 mg/d) or placebo for 2 months, with subsequent weaning over 4-6 months. While proteinuria and eGFR levels were improved in the methylprednisone arm, the trial was stopped after 1.5 years due to serious adverse events. [35]  The TESTING-2 trial is in progress in Asian countries and Australia and Canada; results are expected in 2023. 


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