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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Immunosuppressive agents for treating IgA nephropathy.

Mariacristina Vecchio1, Bibiana Bonerba, Suetonia C Palmer

  • 1Danone Research, RD 128, Palaiseau Cedex, France, 91767.

The Cochrane Database of Systematic Reviews
|August 4, 2015
PubMed
Summary
This summary is machine-generated.

Corticosteroid therapy may slow IgA nephropathy (IgAN) progression and reduce the need for dialysis or transplantation. However, evidence for immunosuppressive treatments is limited, with few high-quality trials available.

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Area of Science:

  • Nephrology
  • Immunology
  • Clinical Trials

Background:

  • IgA nephropathy (IgAN) is a leading cause of end-stage kidney disease (ESKD).
  • This review updates previous findings on IgAN treatments first published in 2003.

Purpose of the Study:

  • To evaluate the benefits and harms of immunosuppressive therapies for IgA nephropathy.
  • To assess the impact of immunosuppression on disease progression and patient outcomes.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
  • Included studies compared immunosuppressive agents against placebo, no treatment, or other agents.
  • Data extraction focused on mortality, infection, ESKD, creatinine doubling, and proteinuria.

Main Results:

  • Corticosteroids reduced progression to ESKD and creatinine doubling, and lowered proteinuria.
  • Combination therapy with steroids and renin-angiotensin-system (RAS) inhibitors further decreased ESKD risk.
  • Mycophenolate mofetil with RAS inhibitors showed promise in reducing ESKD progression and proteinuria.

Conclusions:

  • Corticosteroid therapy may slow IgAN progression and reduce the need for renal replacement therapy.
  • Evidence for immunosuppressive agents is limited by study quality, size, and reporting biases.
  • Larger, well-powered trials are needed to confirm efficacy and assess adverse events.