Frontiers in immunology · 2026
A multicenter retrospective cohort study on the efficacy and safety of mycophenolate mofetil plus hydroxychloroquine therapy in IgA nephropathy.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Yang Yang, Ning Jing, Zeng Fang, Yan Wenjun, Luo Kaiping, Zhou Baoqin, Wang Lijuan, Xu Shizhang, Fu Shufang, Ren Daijin, Xu Gaosi
Аннотация
BACKGROUND: The mechanisms of action of mycophenolate mofetil (MMF) and hydroxychloroquine (HCQ) differ in the treatment of IgA nephropathy (IgAN), and the two may have a synergistic effect in delaying disease progression.
METHODS: This multicenter retrospective cohort study included patients aged 18-60 years with biopsy-confirmed primary IgAN, with 83 patients receiving MMF plus HCQ (combined group) and 94 receiving MMF alone (MMF group). All patients had an estimated glomerular filtration rate > 45 ml/min/1.73 m2 and urine protein (UP) >0.75 g/d after receiving renin-angiotensin-aldosterone system inhibitors for more than 4 weeks. Propensity score matching was performed with a matching ratio of 1:1. The primary outcomes were complete response (CR) and overall remission (OR) rates at 12 months, which were analyzed using the chi-square test. CR was defined as a 24-hour UP ≤0.3 g/d and stable renal function. The OR comprised CR and partial remission. Partial remission was defined as a >50.0% reduction from baseline in UP, with a final level of <1 g/d.
RESULTS: After matching, the CR rates at 12 months were 63.8% (37/58) and 37.9% (22/58) in the combination and MMF groups, respectively (odds ratio: 0.59, 95% CI 0.40-0.87, P = 0.005). OR was achieved by 53 (91.4%) and 43 (74.1%) participants in the combined and MMF groups, respectively (odds ratio: 0.45, 95% CI 0.21-0.99, P = 0.014). Kaplan-Meier analysis also showed that the probability of achieving CR and OR was significantly higher in the combination group (log-rank P = 0.008 and 0.001, respectively). Subgroup analyses showed that patients with UP >2 g/d and eGFR <60 mL/min/1.73 m2 were more likely to achieve OR. The incidence of adverse events was comparable between the two groups.
CONCLUSION: Combination therapy with MMF and HCQ was associated with higher remission rates and greater reduction in UP at 12 months, particularly among those with baseline UP >2 g/d or eGFR between 45 and 60 mL/min/1.73 m², supporting its potential short-term renal benefit.
METHODS: This multicenter retrospective cohort study included patients aged 18-60 years with biopsy-confirmed primary IgAN, with 83 patients receiving MMF plus HCQ (combined group) and 94 receiving MMF alone (MMF group). All patients had an estimated glomerular filtration rate > 45 ml/min/1.73 m2 and urine protein (UP) >0.75 g/d after receiving renin-angiotensin-aldosterone system inhibitors for more than 4 weeks. Propensity score matching was performed with a matching ratio of 1:1. The primary outcomes were complete response (CR) and overall remission (OR) rates at 12 months, which were analyzed using the chi-square test. CR was defined as a 24-hour UP ≤0.3 g/d and stable renal function. The OR comprised CR and partial remission. Partial remission was defined as a >50.0% reduction from baseline in UP, with a final level of <1 g/d.
RESULTS: After matching, the CR rates at 12 months were 63.8% (37/58) and 37.9% (22/58) in the combination and MMF groups, respectively (odds ratio: 0.59, 95% CI 0.40-0.87, P = 0.005). OR was achieved by 53 (91.4%) and 43 (74.1%) participants in the combined and MMF groups, respectively (odds ratio: 0.45, 95% CI 0.21-0.99, P = 0.014). Kaplan-Meier analysis also showed that the probability of achieving CR and OR was significantly higher in the combination group (log-rank P = 0.008 and 0.001, respectively). Subgroup analyses showed that patients with UP >2 g/d and eGFR <60 mL/min/1.73 m2 were more likely to achieve OR. The incidence of adverse events was comparable between the two groups.
CONCLUSION: Combination therapy with MMF and HCQ was associated with higher remission rates and greater reduction in UP at 12 months, particularly among those with baseline UP >2 g/d or eGFR between 45 and 60 mL/min/1.73 m², supporting its potential short-term renal benefit.