Reduced-Dose Methylprednisolone Boosts Kidney Health in High-Risk IgAN but Increases SAEs: TESTING analysis

Patients with IgAN, proteinuria ≥1 g/d despite three months of renin-angiotensin-system blockade, and estimated glomerular filtration rate (eGFR) of 30 to 120 ml/min per 1.73 m2 were included between 2017 and 2019. They were randomized to reduced-dose methylprednisolone 0.4 mg/kg/d or placebo. The primary outcome was a composite of a 40% decline in eGFR, kidney failure, or mortality due to kidney disease.

The researchers reported the following findings:

• Two hundred and forty-one participants were randomized and followed for a median of 2.5 years (mean age: 37 years; baseline eGFR: 65 ml/min per 1.73 m2; proteinuria: 2.48 g/d).
• Methylprednisolone was associated with fewer primary outcome events compared to placebo (7/121 versus 22/120; hazard ratio [HR]: 0.24), lowered proteinuria, and reduced eGFR rate of decline from baseline.
• The mean difference between methylprednisolone and placebo in proteinuria and eGFR from baseline was −1.15 g/d and 7.9 ml/min per 1.73 m2 at 12 months, respectively; however, these benefits were lost over time.
• There were seven versus 3 SAEs in the methylprednisolone versus placebo group (HR: 1.97), including five versus two infections.

Reduced-dose methylprednisolone is effective in enhancing kidney outcomes for high-risk IgAN patients; however, it is associated with a modest increase in serious adverse events (SAEs) compared to placebo, the researchers concluded.

Reference:

Kim, D., Lv, J., Hladunewich, M., Jha, V., Hooi, L. S., Monaghan, H., Shan, S., Reich, H. N., Barbour, S., Billot, L., Zhang, H., Perkovic, V., & Wong, M. G. (2024). The Efficacy and Safety of Reduced-Dose Oral Methylprednisolone in High-Risk Immunoglobulin A Nephropathy. Kidney International Reports, 9(7), 2168-2179. https://doi.org/10.1016/j.ekir.2024.03.032