What is the efficacy of supportive care for 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

The Supportive Versus Immunosuppressive Therapy for the Treatment of Progressive IgA Nephropathy (STOP-IgAN) trial showed that after 3 years, full clinical remission had occurred in 5% of patients in the supportive-care group, as compared with 17% of patients who received immunosuppression with steroids plus cyclophosphamide followed by azathioprine. STOP-IgAN enrolled patients 18-70 years of age with proteinuria > 0.75 g/day with hypertension and GFR of 30-90 mL/min/1.73 m2. Patients with crescentic lesions were excluded. [37]

The primary end point was UPCR < 0.2 g/day and a decrease in eGFR < 5 mL/min/1.73 mfrom baseline at 3 years. There was no significant difference in the annual decline in eGFR between the two groups, and patients in the immunosuppression arm were more likely to experience significant adverse effects (severe infections, impaired glucose tolerance, and weight gain of more than 5 kg in the first year of treatment). [37]

The STOP-IgAN authors note that the study results do not apply to patients who have proteinuria > 3.5 g/day, as such patients have a very high risk of progression and have been reported to have a particularly good response to corticosteroids. [37]  Thus, use of immunosuppression should be considered only for patients with active disease and rapid progression.


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