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자료유형
학술저널
저자정보
한상엽 (인제대학교) 정찬영 (연세대학교 의과대학) 김범석 (연세대학교) 이상호 (강동경희대학교병원) 이동원 (부산대학교) 이식 (전북대학교) 김찬덕 (경북대학교) 최범순 (가톨릭대학교)
저널정보
대한신장학회 Kidney Research and Clinical Practice Kidney Research and Clinical Practice Vol.41 No.4
발행연도
2022.7
수록면
452 - 461 (10page)
DOI
10.23876/j.krcp.21.146

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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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