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논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2022.7
- 수록면
- 452 - 461 (10page)
- DOI
- 10.23876/j.krcp.21.146
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초록· 키워드
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Background: It remains unclear whether immunosuppressive agents are effective in patients with immunoglobulin A nephropathy(IgAN). We investigated the efficacy of a mycophenolate mofetil (MMF) and corticosteroid combination therapy in patients with advanced IgAN.
Methods: We conducted a multicenter, randomized, placebo-controlled, parallel-group study of 48 weeks administration of MMF andcorticosteroids in biopsy-proven advanced IgAN patients with estimated glomerular filtration rate (eGFR) of 20–50 mL/min/1.73 m2and urine protein-to-creatinine ratio (UPCR) of >0.75 g/day. The primary outcome was complete (UPCR < 0.3 g/day) or partial (>50%reduction of UPCR compared to baseline) remission at 48 weeks.
Results: Among the 48 randomized patients, the percentage that achieved complete or partial remission was greater in the combination therapy group than in the control group (4.2% vs. 0% and 29.1% vs. 5.0%, respectively). Compared with the combination therapygroup, eGFR in the control group decreased significantly from week 36 onward, resulting in a final adjusted mean change of –4.39 ±1.22 mL/min/1.73 m2(p = 0.002). The adjusted mean changes after 48 weeks were 0.62 ± 1.30 and –5.11 ± 1.30 mL/min/1.73m2(p = 0.005) in the treatment and control groups, respectively. The UPCR was significantly different between the two groups; theadjusted mean difference was –0.47 ± 0.17 mg/mgCr and 0.07 ± 0.17 mg/mgCr in the treatment and control group, respectively (p= 0.04). Overall adverse events did not differ between the groups.
Conclusion: In advanced IgAN patients with a high risk for disease progression, combined MMF and corticosteroid therapy appearsto be beneficial in reducing proteinuria and preserving renal function.
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