Abstract：
BACKGROUND: The renoprotective benefits of adding immunosuppressant therapy to corticosteroid (CS) treatment for immunoglobulin A nephropathy (IgAN) patients with less than 25% crescent formation (C1) remain uncertain, warranting further research.
METHODS: A retrospective study was conducted on IgAN patients with crescent C1 lesions confirmed by renal biopsy at Xinqiao Hospital between May 1, 2017, and May 1, 2020. Patients were stratified into either the CS treatment group or the CS combined with an additional immunosuppressant therapy group. Follow-up assessments were conducted within 24 months. Propensity score analysis was used to match patients receiving CS and CS + immunosuppressant drug treatment in a 1:1 ratio. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Subgroup analyses were performed to evaluate the benefits of different populations. Composite endpoint outcomes comprised a 30% eGFR decrease, end-stage kidney disease (ESKD) necessitating dialysis or transplant, or kidney disease-related mortality. Adverse events were also compared between the two groups.
RESULTS: 296 IgAN patients with C1 lesions were included in the analysis. Baseline characteristics indicated that IgAN patients in the CS + immunosuppressant group exhibited poorer renal function and higher UACR levels. Propensity score analysis effectively minimized the influence of baseline clinical characteristics, including age, serum creatinine, initial eGFR, UACR, and 24-h proteinuria. Both treatment groups demonstrated continuous eGFR improvement and significant UACR reduction during follow-up, especially at 6 months. However, no significant differences in eGFR and UACR reduction rates were observed between the two groups throughout the entire follow-up period, both before and after matching. Subgroup analysis revealed improved eGFR in both treatment groups, notably among patients with an initial eGFR below 90 mL/min/1.73 m2. Conversely, IgAN patients with C1 lesions and a cellular crescent ratio exceeding 50% treated with CS and immunosuppressant therapy experienced a significant improvement in renal function and a decline in urinary protein creatinine ratio. Composite endpoint outcomes did not significantly differ between the two groups, while the incidence of adverse events was comparable.
CONCLUSIONS: Our findings suggest that the addition of immunosuppressant therapy to corticosteroid monotherapy did not confer significant therapeutic advantages in patients with C1 lesions compared to CS monotherapy, although some specific patient populations appeared to derive modest benefits from this combined approach.
METHODS: A retrospective study was conducted on IgAN patients with crescent C1 lesions confirmed by renal biopsy at Xinqiao Hospital between May 1, 2017, and May 1, 2020. Patients were stratified into either the CS treatment group or the CS combined with an additional immunosuppressant therapy group. Follow-up assessments were conducted within 24 months. Propensity score analysis was used to match patients receiving CS and CS + immunosuppressant drug treatment in a 1:1 ratio. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Subgroup analyses were performed to evaluate the benefits of different populations. Composite endpoint outcomes comprised a 30% eGFR decrease, end-stage kidney disease (ESKD) necessitating dialysis or transplant, or kidney disease-related mortality. Adverse events were also compared between the two groups.
RESULTS: 296 IgAN patients with C1 lesions were included in the analysis. Baseline characteristics indicated that IgAN patients in the CS + immunosuppressant group exhibited poorer renal function and higher UACR levels. Propensity score analysis effectively minimized the influence of baseline clinical characteristics, including age, serum creatinine, initial eGFR, UACR, and 24-h proteinuria. Both treatment groups demonstrated continuous eGFR improvement and significant UACR reduction during follow-up, especially at 6 months. However, no significant differences in eGFR and UACR reduction rates were observed between the two groups throughout the entire follow-up period, both before and after matching. Subgroup analysis revealed improved eGFR in both treatment groups, notably among patients with an initial eGFR below 90 mL/min/1.73 m2. Conversely, IgAN patients with C1 lesions and a cellular crescent ratio exceeding 50% treated with CS and immunosuppressant therapy experienced a significant improvement in renal function and a decline in urinary protein creatinine ratio. Composite endpoint outcomes did not significantly differ between the two groups, while the incidence of adverse events was comparable.
CONCLUSIONS: Our findings suggest that the addition of immunosuppressant therapy to corticosteroid monotherapy did not confer significant therapeutic advantages in patients with C1 lesions compared to CS monotherapy, although some specific patient populations appeared to derive modest benefits from this combined approach.
摘要：
背景：对于新月形成率低于25%的免疫球蛋白A肾病（IgAN）患者，在皮质类固醇（CS）治疗的基础上增加免疫抑制剂治疗的肾脏保护益处仍不确定。保证进一步的研究。方法回顾性分析2017年5月1日至2020年5月1日在新桥医院经肾活检证实的IgAN伴新月形C1病变患者的临床资料。将患者分为CS治疗组或CS联合其他免疫抑制剂治疗组。随访评估在24个月内进行。使用倾向评分分析以1:1比例匹配接受CS和CS+免疫抑制剂药物治疗的患者。主要结果包括估计肾小球滤过率（eGFR）和尿白蛋白-肌酐比值（UACR）的变化。进行亚组分析以评估不同人群的益处。复合终点结果包括eGFR下降30%，终末期肾病（ESKD）需要透析或移植，或肾脏疾病相关死亡率。比较两组患者的不良事件。结果：296例IgAN患者C1病变纳入分析。基线特征表明CS免疫抑制剂组的IgAN患者表现出较差的肾功能和较高的UACR水平。倾向评分分析有效地降低了基线临床特征的影响，包括年龄,血清肌酐,初始eGFR，UACR,和24小时蛋白尿。两个治疗组在随访期间表现出持续的eGFR改善和显著的UACR降低,尤其是6个月。然而,在整个随访期间，两组之间的eGFR和UACR降低率没有显着差异，匹配之前和之后。亚组分析显示，两个治疗组的eGFR均得到改善，尤其是初始eGFR低于90ml/min/1.73m2的患者。相反，用CS和免疫抑制剂治疗的C1病变和细胞新月比率超过50％的IgAN患者的肾功能显着改善，尿蛋白肌酐比率下降。两组之间的复合终点结果没有显着差异，而不良事件的发生率相当。结论我们的研究结果表明，与CS单药治疗相比，在C1病变患者中，在皮质类固醇单药治疗中加入免疫抑制剂治疗并没有带来明显的治疗优势。尽管一些特定的患者人群似乎从这种联合方法中获得了适度的益处.
