Steroids May Increase Infection Risk in Patients with IgA Nephropathy

Despite the observed lower risk for kidney failure, the authors concluded that, due to early termination of the trial, it was impossible to state with any certainty that the treatment was effective. However, the study’s suggestion that there is a renal benefit from treatment with oral methylprednisolone is consistent with a meta-analysis of nine smaller trials, which found that corticosteroid therapy was associated with a lower risk of composite renal outcomes.² The current results and meta-analysis, however, contrast with recent results from the (Supportive vs. Immunosuppressive Therapy for the Treatment of Progressive IgA Nephropathy) STOP-IgAN study, which found no effect of immunosuppression on the slope of eGFR decline or ESKD.³

Lara C. Pullen, PhD, is a medical writer based in the Chicago area.

Reference

1. Lv J, Zhang H, Wong MG, et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: The TESTING randomized clinical trial. JAMA. 2017 Aug 1;318(5):432–442. doi: 10.1001/jama.2017.9362.
2. Inker LA, Mondal H, Greene T, et al. Early change in urine protein as a surrogate end point in studies of IgA nephropathy: An individual-patient meta-analysis. Am J Kidney Dis. 2016 Sep;68(3):392­–401. doi: 10.1053/j.ajkd.2016.02.042. Epub 2016 Mar 29.
3. Schena FP, Manno C. Intensive supportive care plus immunosuppression in IgA nephropathy. N Engl J Med. 2016 Mar 10;374(10):992. doi: 10.1056/NEJMc1600141#SA3.