Ali Sarah N, Fusco Nicole, Makhija Dilip, Diaby Vakaramoko, Oladapo Tosin, Devani Darsh, Pinto Cibele, Mathur Mohit, Fernandes Ancilla W
Otsuka Pharmaceutical Development and Commercialization, 508 Carnegie Center, Princeton, NJ, 08540, USA.
Cencora, Conshohocken, PA, USA.
BMC Nephrol. 2025 May 19;26(1):249. doi: 10.1186/s12882-025-04155-7.
Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis (GN) worldwide. While specific treatment differs regionally, treatment usually focuses on background therapy, with short-term (≤ 6 months) corticosteroids recommended as an add-on treatment for patients at high risk of progressive chronic kidney disease. Although corticosteroids can help to manage IgAN, treatment with corticosteroids may lead to undesirable adverse outcomes.
To highlight corticosteroid treatment burden in patients with IgAN globally.
Embase, MEDLINE, and Cochrane CENTRAL were searched for articles published in any language from January 1, 2013 to August 24, 2023. Eligible studies reported ≥ 1 outcome related to the clinical, humanistic, or economic burden of corticosteroids in patients with IgAN. Articles were independently screened by 2 reviewers. Data extraction and quality assessment were completed by 1 researcher and validated by a second. Results are reported among the number of studies with data on each outcome.
Of 1,024 records screened, 64 studies were included. Of 37 studies reporting treatment duration, 68% found that corticosteroids were used long-term (range: 8-24 months). In studies reporting data for long-term use (> 6 months), there were more overall AEs and serious AEs with corticosteroids than with comparator treatments (e.g., background therapy alone, tonsillectomy, placebo). Rates of metabolic AEs, Cushing's syndrome, edema and sleep disorders were also higher with long-term corticosteroids than with comparator treatments; however, most studies did not report the statistical significance of these results. Infection rates were similar between corticosteroids and comparator treatments.
Current guidelines recommend short-term corticosteroid treatment for patients at high risk of progression but long-term use appears to be widespread. Corticosteroids may lead to adverse outcomes and should therefore be reserved only for IgAN patients most at risk of rapid progression to end-stage kidney disease and for limited duration. Novel corticosteroid-sparing therapies are necessary to supplement the current treatment landscape.
免疫球蛋白A肾病（IgAN）是全球原发性肾小球肾炎（GN）最常见的形式之一。虽然具体治疗因地区而异，但治疗通常侧重于背景治疗，对于有进展为慢性肾病高风险的患者，建议短期（≤6个月）使用皮质类固醇作为附加治疗。尽管皮质类固醇有助于管理IgAN，但使用皮质类固醇治疗可能会导致不良后果。
强调全球IgAN患者使用皮质类固醇的治疗负担。
检索Embase、MEDLINE和Cochrane CENTRAL中2013年1月1日至2023年8月24日以任何语言发表的文章。符合条件的研究报告了≥1项与IgAN患者使用皮质类固醇的临床、人文或经济负担相关的结果。文章由2名评审员独立筛选。数据提取和质量评估由1名研究人员完成，并由另一名研究人员进行验证。结果按每项结果有数据的研究数量报告。
在筛选的1024条记录中，纳入了64项研究。在报告治疗持续时间的37项研究中，68%发现皮质类固醇长期使用（范围：8 - 24个月）。在报告长期使用（>6个月）数据的研究中，与对照治疗（如仅背景治疗、扁桃体切除术、安慰剂）相比，皮质类固醇的总体不良事件和严重不良事件更多。长期使用皮质类固醇时，代谢不良事件、库欣综合征、水肿和睡眠障碍的发生率也高于对照治疗；然而，大多数研究未报告这些结果的统计学意义。皮质类固醇与对照治疗的感染率相似。
当前指南建议对有高进展风险的患者进行短期皮质类固醇治疗，但长期使用似乎很普遍。皮质类固醇可能导致不良后果，因此应仅保留给最有快速进展至终末期肾病风险的IgAN患者，并在有限的时间内使用。需要新的皮质类固醇节省疗法来补充当前的治疗格局。
