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Author Spotlight: Investigating the Potential of Chinese Herbal Medicinal Active Dioscin in Treating IgA Nephropathy
Published on: October 13, 2023
Intensive Supportive Care plus Immunosuppression in IgA Nephropathy
Thomas Rauen1, Frank Eitner, Christina Fitzner
1From the Division of Nephrology and Clinical Immunology (T.R., F.E., J.F.) and Department of Medical Statistics (C.F., R.-D.H.), RWTH Aachen University, Aachen, Bayer Pharma, Kidney Diseases Research, Wuppertal (F.E.), Department of Nephrology, University of Heidelberg, Heidelberg (C.S., M.Z.), Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster (B.O.), University Medical Center Hamburg-Eppendorf, Hamburg (U.P.), Department of Nephrology and Dieter Scheffner Center for Medical Education, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin (H.P.), Department of Medicine V, University Medical Center Mannheim, University of Heidelberg, Mannheim (U.B.), Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg (P.R.M.), Medical Clinic III, Central Hospital Bremen, Bremen (U.K.), Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen (O.W.), Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen (O.G.), and Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität (V.V.), and Department of Nephrology, Hypertension and Rheumatology, Munich General Hospital (J.F.E.M.), Munich - all in Germany.
Adding immunosuppressive therapy to supportive care for IgA nephropathy did not improve outcomes. Patients receiving immunosuppression experienced more adverse effects without a significant change in estimated glomerular filtration rate decline.
Area of Science:
- Nephrology
- Immunology
- Clinical Trials
Background:
- IgA nephropathy (IgAN) is a common cause of glomerulonephritis.
- The efficacy of immunosuppressive therapy in IgAN remains uncertain.
Purpose of the Study:
- To evaluate the effectiveness of adding immunosuppressive therapy to supportive care for patients with high-risk IgA nephropathy.
- To assess the impact on clinical remission and estimated glomerular filtration rate (eGFR) decline.
Main Methods:
- Multicenter, open-label, randomized controlled trial.
- 3-year study comparing supportive care alone versus supportive care plus immunosuppressive therapy.
- Primary endpoints included full clinical remission and eGFR decline.
Main Results:
- 17% of patients receiving immunosuppression achieved full remission vs. 5% with supportive care alone (P=0.01).
- No significant difference in eGFR decline (26% vs. 28%, P=0.75) or annual decline rate between groups.
- Increased severe infections, impaired glucose tolerance, and weight gain observed in the immunosuppression group.
Conclusions:
- Immunosuppressive therapy did not significantly improve outcomes in high-risk IgAN patients.
- Adverse effects were more frequent with immunosuppression without altering eGFR decline.
- Intensive supportive care, including renin-angiotensin system blockade, is crucial.
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