Nephrologie & therapeutique · 2026
Effect of on-demand immunosuppressive therapy on long-term outcomes in patients with immunoglobulin A nephropathy: A real-world cohort study.
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Zhao Xingyi, Fan Xiaohong, Wu Haiting, Wen Yubing, Gao Ruitong, Chen Limeng, Li Xuemei
Аннотация
BACKGROUND: Long-term management strategies for IgA Nephropathy (IgAN) remain insufficiently studied. This study aims to address this gap by comparing patients with persistent proteinuria who did not receive additional treatment with those whose persistent proteinuria led to on-demand immunosuppressive treatment.
METHODS: This retrospective cohort study included 264 propensity score-matched patients with IgAN treated between January 2003 and December 2016, with a follow-up through August 2024. Patients with proteinuria ≥1g/day without a 40% decline in eGFR over the previous 3 months, despite adequate supportive therapy, were considered eligible for on-demand immunosuppressive therapy during follow-up. Effective regimens-including glucocorticoids, cyclophosphamide, or mycophenolate mofetil, alone or in combination with other immunosuppressive drugs-were considered distinct treatment courses only if separated by at least six months. Survival was analyzed using the Kaplan-Meier estimator, and the primary composite endpoint was analyzed using the Cox proportional hazards model.
RESULTS: Over a median follow-up of 9.9 years (interquartile range, 7.3-12.8 years), 65 of 264 (25%) experienced the primary composite endpoint. Risk was lower among patients who consistently received on-demand immunosuppressive therapy compared with those who did not (10/132 [8%] vs. 55/132 [42%]; hazard ratio, 0.11; 95% CI, 0.05-0.21; p < 0.001). The incidence of the primary endpoint increased progressively with the number of missed on-demand immunosuppressive therapy: 27/34 (79%), 17/34 (50%), and 11/64 (17%) among patients who missed 3 or more, 2, or 1 treatment(s) respectively. Of the 281 missed on-demand treatment opportunities, 107 (38%) were attributable to patient-related factors and 174 (62%) to physician-related factors.
CONCLUSIONS: On-demand immunosuppressive therapy is associated with improved long-term outcomes in patients with IgAN.
METHODS: This retrospective cohort study included 264 propensity score-matched patients with IgAN treated between January 2003 and December 2016, with a follow-up through August 2024. Patients with proteinuria ≥1g/day without a 40% decline in eGFR over the previous 3 months, despite adequate supportive therapy, were considered eligible for on-demand immunosuppressive therapy during follow-up. Effective regimens-including glucocorticoids, cyclophosphamide, or mycophenolate mofetil, alone or in combination with other immunosuppressive drugs-were considered distinct treatment courses only if separated by at least six months. Survival was analyzed using the Kaplan-Meier estimator, and the primary composite endpoint was analyzed using the Cox proportional hazards model.
RESULTS: Over a median follow-up of 9.9 years (interquartile range, 7.3-12.8 years), 65 of 264 (25%) experienced the primary composite endpoint. Risk was lower among patients who consistently received on-demand immunosuppressive therapy compared with those who did not (10/132 [8%] vs. 55/132 [42%]; hazard ratio, 0.11; 95% CI, 0.05-0.21; p < 0.001). The incidence of the primary endpoint increased progressively with the number of missed on-demand immunosuppressive therapy: 27/34 (79%), 17/34 (50%), and 11/64 (17%) among patients who missed 3 or more, 2, or 1 treatment(s) respectively. Of the 281 missed on-demand treatment opportunities, 107 (38%) were attributable to patient-related factors and 174 (62%) to physician-related factors.
CONCLUSIONS: On-demand immunosuppressive therapy is associated with improved long-term outcomes in patients with IgAN.