Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
Key Laboratory of Renal Disease, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Health of China, Ministry of Education, Beijing, China.
BMC Nephrol. 2023 Jun 15;24(1):175. doi: 10.1186/s12882-023-03238-7.
Hydroxychloroquine (HCQ) is recommended as a treatment for IgA nephropathy (IgAN) to control proteinuria. The long-term effects of HCQ compared to systemic corticosteroid therapy remain unclear.
We conducted a retrospective case‒control study at Peking University First Hospital. Thirty-nine patients with IgAN who received HCQ for at least 24 months without corticosteroids (CSs) or other immunosuppressive agents were included. Thirty-nine matched patients who received systemic CS therapy were selected using propensity score matching. Clinical data over a 24-month period were compared.
In the HCQ group, the level of proteinuria decreased from 1.72 [1.44, 2.35] to 0.97 [0.51, 1.37] g/d (-50.5 [-74.0, -3.4] %, P < 0.001) at 24 months. A significant decline in proteinuria was also found in the CS group, but no significant differences were found between the HCQ group and CS group in the levels of proteinuria (0.97 [0.51, 1.37] vs. 0.53 [0.25, 1.81] g/d, P = 0.707) and change rates (-50.5% [-74.0%, -3.4%] vs. -63.7% [-78.5%, -24.2%], P = 0.385) at 24 months. In addition, the decline rates of eGFR between the HCQ and CS groups were comparable (-7.9% [-16.1%, 5.8%] vs. -6.6% [-14.9%, 5.3%], P = 0.758). More adverse events were observed in the CS group.
Long-term use of HCQ can maintain stable renal function with minimal side effects. In patients who cannot tolerate corticosteroids, HCQ might be an effective and safe supportive therapy for IgAN.
羟氯喹 (HCQ) 被推荐用于 IgA 肾病 (IgAN) 的治疗以控制蛋白尿。与全身皮质类固醇治疗相比，HCQ 的长期效果仍不清楚。
我们在北京大学第一医院进行了一项回顾性病例对照研究。39 例接受 HCQ 治疗至少 24 个月且未使用皮质类固醇 (CSs) 或其他免疫抑制剂的 IgAN 患者被纳入本研究。采用倾向评分匹配法选择 39 例接受全身 CS 治疗的匹配患者。比较了 24 个月期间的临床数据。
在 HCQ 组中，蛋白尿水平从 1.72[1.44, 2.35]降至 0.97[0.51, 1.37]g/d（-50.5[-74.0, -3.4]%，P<0.001），在 24 个月时。CS 组也发现蛋白尿显著下降，但 HCQ 组和 CS 组的蛋白尿水平（0.97[0.51, 1.37]与 0.53[0.25, 1.81]g/d，P=0.707）和变化率（-50.5%[-74.0%, -3.4%]与 -63.7%[-78.5%, -24.2%]，P=0.385）在 24 个月时无显著差异。此外，HCQ 组和 CS 组的 eGFR 下降率相似（-7.9%[-16.1%, 5.8%]与 -6.6%[-14.9%, 5.3%]，P=0.758）。CS 组观察到更多的不良反应。
长期使用 HCQ 可以维持肾功能稳定，副作用最小。对于不能耐受皮质类固醇的患者，HCQ 可能是 IgAN 的一种有效且安全的支持治疗方法。
