PDF(Pubmed)
Abstract：
OBJECTIVE: To date, our understanding of IgA nephropathy (IgAN) pathophysiology has remained incomplete; therefore, treatment remains largely empiric, and the efficacy and safety of immunosuppressants remain controversial. We aimed to assess the efficacy and safety of hydroxychloroquine and leflunomide therapy in a retrospective cohort of patients with IgAN.
METHODS: We screened the IgAN registration database in our department, and a total of 159 kidney patients with biopsy-confirmed IgAN were enrolled, with 57 patients receiving hydroxychloroquine plus a renin-angiotensin system inhibitor (hydroxychloroquine group), 52 patients receiving leflunomide plus a renin-angiotensin system inhibitor (leflunomide group), and 50 patients receiving only a renin-angiotensin system inhibitor (renin-angiotensin system inhibitor-only group). Changes in proteinuria, hematuria, and the estimated glomerular filtration rate (eGFR), as well as adverse events, were analyzed during the follow-up period.
RESULTS: At the end of 6-month follow-up, proteinuria significantly decreased by 70.36 (57.54, 79.33)%, 57.29 (46.79, 67.29)% and 41.20 (25.76, 48.94)% in the hydroxychloroquine, leflunomide and renin-angiotensin system inhibitor-only groups, respectively, compared to baseline (all P values < 0.001). Hematuria significantly decreased by 71.07 (56.48, 82.47)% in the leflunomide group (P < 0.001). The eGFR improved by 3.72 ± 2.97%, 3.16 ± 2.00% and 1.91 ± 2.41%, respectively, in the hydroxychloroquine, leflunomide and renin-angiotensin system inhibitor-only groups, but without statistical significance. No serious adverse events occurred during the follow-up period.
CONCLUSIONS: Both hydroxychloroquine combined with a renin-angiotensin system inhibitor and leflunomide combined with a renin-angiotensin system inhibitor were more effective than a renin-angiotensin system inhibitor alone in improving proteinuria in IgAN patients. Hydroxychloroquine was more effective in reducing proteinuria, and leflunomide showed superiority in reducing hematuria. Our results need to be verified in large-scale randomized controlled trials.
METHODS: We screened the IgAN registration database in our department, and a total of 159 kidney patients with biopsy-confirmed IgAN were enrolled, with 57 patients receiving hydroxychloroquine plus a renin-angiotensin system inhibitor (hydroxychloroquine group), 52 patients receiving leflunomide plus a renin-angiotensin system inhibitor (leflunomide group), and 50 patients receiving only a renin-angiotensin system inhibitor (renin-angiotensin system inhibitor-only group). Changes in proteinuria, hematuria, and the estimated glomerular filtration rate (eGFR), as well as adverse events, were analyzed during the follow-up period.
RESULTS: At the end of 6-month follow-up, proteinuria significantly decreased by 70.36 (57.54, 79.33)%, 57.29 (46.79, 67.29)% and 41.20 (25.76, 48.94)% in the hydroxychloroquine, leflunomide and renin-angiotensin system inhibitor-only groups, respectively, compared to baseline (all P values < 0.001). Hematuria significantly decreased by 71.07 (56.48, 82.47)% in the leflunomide group (P < 0.001). The eGFR improved by 3.72 ± 2.97%, 3.16 ± 2.00% and 1.91 ± 2.41%, respectively, in the hydroxychloroquine, leflunomide and renin-angiotensin system inhibitor-only groups, but without statistical significance. No serious adverse events occurred during the follow-up period.
CONCLUSIONS: Both hydroxychloroquine combined with a renin-angiotensin system inhibitor and leflunomide combined with a renin-angiotensin system inhibitor were more effective than a renin-angiotensin system inhibitor alone in improving proteinuria in IgAN patients. Hydroxychloroquine was more effective in reducing proteinuria, and leflunomide showed superiority in reducing hematuria. Our results need to be verified in large-scale randomized controlled trials.
摘要：
目标：迄今为止，我们对IgA肾病（IgAN）病理生理学的理解仍然不完整；因此，治疗在很大程度上仍然是经验性的，免疫抑制剂的有效性和安全性仍存在争议。我们旨在评估羟氯喹和来氟米特治疗IgAN患者的疗效和安全性。
方法：我们筛选了我们部门的IgAN注册数据库，共纳入159例经活检证实为IgAN的肾脏患者，57例患者接受羟氯喹加肾素-血管紧张素系统抑制剂（羟氯喹组），52例接受来氟米特加肾素-血管紧张素系统抑制剂的患者（来氟米特组），50例仅接受肾素-血管紧张素系统抑制剂的患者（仅肾素-血管紧张素系统抑制剂组）。蛋白尿的变化，血尿,和估计的肾小球滤过率(eGFR)，以及不良事件，在随访期间进行了分析。
结果：在6个月的随访结束时，蛋白尿显著减少70.36(57.54,79.33)%,羟氯喹中的57.29（46.79，67.29）％和41.20（25.76，48.94）％，来氟米特和仅肾素-血管紧张素系统抑制剂组，分别,与基线相比（所有P值<0.001）。来氟米特组血尿显著下降71.07(56.48,82.47)%(P<0.001)。eGFR提高了3.72±2.97%，3.16±2.00%和1.91±2.41%，分别,在羟氯喹中，来氟米特和仅肾素-血管紧张素系统抑制剂组，但没有统计学意义。随访期间无严重不良事件发生。
结论：羟氯喹联合肾素-血管紧张素系统抑制剂和来氟米特联合肾素-血管紧张素系统抑制剂在改善IgAN患者蛋白尿方面比单独肾素-血管紧张素系统抑制剂更有效。羟氯喹在减少蛋白尿方面更有效，来氟米特在减少血尿方面具有优势。我们的结果需要在大规模随机对照试验中得到验证。
方法：我们筛选了我们部门的IgAN注册数据库，共纳入159例经活检证实为IgAN的肾脏患者，57例患者接受羟氯喹加肾素-血管紧张素系统抑制剂（羟氯喹组），52例接受来氟米特加肾素-血管紧张素系统抑制剂的患者（来氟米特组），50例仅接受肾素-血管紧张素系统抑制剂的患者（仅肾素-血管紧张素系统抑制剂组）。蛋白尿的变化，血尿,和估计的肾小球滤过率(eGFR)，以及不良事件，在随访期间进行了分析。
结果：在6个月的随访结束时，蛋白尿显著减少70.36(57.54,79.33)%,羟氯喹中的57.29（46.79，67.29）％和41.20（25.76，48.94）％，来氟米特和仅肾素-血管紧张素系统抑制剂组，分别,与基线相比（所有P值<0.001）。来氟米特组血尿显著下降71.07(56.48,82.47)%(P<0.001)。eGFR提高了3.72±2.97%，3.16±2.00%和1.91±2.41%，分别,在羟氯喹中，来氟米特和仅肾素-血管紧张素系统抑制剂组，但没有统计学意义。随访期间无严重不良事件发生。
结论：羟氯喹联合肾素-血管紧张素系统抑制剂和来氟米特联合肾素-血管紧张素系统抑制剂在改善IgAN患者蛋白尿方面比单独肾素-血管紧张素系统抑制剂更有效。羟氯喹在减少蛋白尿方面更有效，来氟米特在减少血尿方面具有优势。我们的结果需要在大规模随机对照试验中得到验证。
