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Reduced-Dose Methylprednisolone Boosts Kidney Health in High-Risk IgAN but Increases SAEs: TESTING analysis
Australia: A tapered regimen of reduced-dose oral methylprednisolone administered over 6 to 9 months significantly enhances kidney outcomes in patients with high-risk IgA nephropathy (IgAN), as revealed by a prespecified secondary analysis of the reduced-dose group in the global Therapeutic Effects of Steroids in IgAN (TESTING) trial.
The study, published in Kidney International Reports, also noted that the reduced-dose regimen is associated with a modestly higher number of serious adverse events (SAEs) compared to placebo.
"Results indicated that a 0.4 mg/kg/d methylprednisolone regimen is linked to a 76% reduction in the risk of the primary composite kidney outcome compared to supportive care alone. Additionally, the study highlighted that this treatment delays the progression to kidney failure in patients already receiving maximal supportive care," the researchers reported.
The global TESTING study found that methylprednisolone lowers the risk of major kidney events in high-risk IgAN patients compared to supportive care alone, though it is linked to a higher incidence of SAEs, particularly with full-dose therapy. In the prespecified analysis of the reduced-dose cohort from the TESTING trial, Dana Kim, The George Institute for Global Health, University of New South Wales, Sydney, Australia, and colleagues evaluated the risk-benefit balance of the reduced-dose methylprednisolone regimen.
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
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751