Budesonide versus systemic corticosteroids in IgA Nephropathy: A retrospective, propensity-matched comparison. Issue 26 (26th June 2020)

• Record Type: Journal Article
• Authors: Ismail, Gener; Obrişcă, Bogdan; Jurubiţă, Roxana; Andronesi, Andreea; Sorohan, Bogdan; Vornicu, Alexandra; Sinescu, Ioanel; Hârza, Mihai
• Other Names: Aeddula. Narothama Reddy section editor.
• Is Part Of: Medicine. Volume 99:Issue 26(2020)
• Publication Date: 2020-06-26
• Subjects: budesonide -- corticosteroids -- IgA Nephropathy -- immunosuppression; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000021000
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: IgA Nephropathy (IgAN) is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 molecules of gut-associated lymphoid tissue origin. We sought to evaluate the efficacy of targeting the mucosal immune system dysregulation underlying IgAN pathogenesis with a pH-modified formulation of budesonide with a maximum release of active compound in the distal ileum and proximal colon. We did a retrospective study evaluating the efficacy of budesonide (Budenofalk) in the treatment of IgAN. From a retrospective cohort of 143 patients with IgAN followed in our department we identified 21 patients that received treatment with budesonide. These patients received budesonide at a dose of 9 mg/d in the first 12 months, followed by a dose reduction to 3 mg/d for the subsequent period. Only patients that received a 24-month treatment with budesonide were included in the analysis (n = 18). We matched the budesonide-treated cohort to 18 patients with IgAN treated with systemic steroids from the same retrospective cohort. Efficacy was measured as change in proteinuria, hematuria and estimated glomerular filtration rate over a 24-month period. Treatment with budesonide was associated with a 24-month renal function decline of -0.22 (95%CI, -8.2 to 7.8) ml/min/1.73m 2, compared to -5.89 (95%CI, -12.2 to 0.4) ml/min/1.73m 2 in the corticosteroid treatment group (p = 0.44, for between group difference). The median reduction in proteinuria at 24-month was 45% (interquartile range [IQR]: -79%; -22%) in the budesonide group and 11% (IQR: -39%; 43%) in the corticosteroid group, respectively ( P = .009, for between group difference). The median reduction in hematuria at 24-month was 72% (IQR: -90%; -45%) in the budesonide group and 73% (IQR: -85%; 18%) in the corticosteroid group, respectively ( P = .22, for between group difference). Treatment with budesonide was well tolerated with minimal side effects. Budesonide (Budenofalk) was effective in the treatment of patients with IgAN at high-risk of progression in terms of reducing proteinuria, hematuria and preserving renal function over 24 months of therapy.