#VisualAbstract: Comparison between hydroxychloroquine and systemic corticosteroids in IgA nephropathy

1. For patients with IgA nephropathy (IgAN), long-term use of hydroxychloroquine demonstrated antiproteinuric effects compared to corticosteroids at 24 months. 

Evidence Rating Level: 3 (Average)

IgAN is the most common form of primary glomerulonephritis, occurring in 1 in 100 people worldwide, and can lead to end-stage renal disease. No specific treatment currently exists for IgAN, but corticosteroids (CS) are widely used as supportive treatment to maintain renal function in patients, despite their significant side effects. This retrospective case-control study aimed to evaluate the long-term antiproteinuric and reno-protective efficacy of HCQ compared to systemic CS. From a single center in China, 39 eligible patients with IgAN who received HCQ treatment for 24 months were identified and propensity score-matched to 39 controls who received systemic CS. In both the CS and HCQ group, the level of proteinuria significantly decreased from baseline at 12 and 24 months (P <0.001). At 12 months, there was no significant difference in proteinuria levels between groups (0.85 [0.50, 1.41] vs. 0.54 [0.19, 0.89] g/d, P = 0.099). However, the HCQ group exhibited a smaller percentage of proteinuria reduction at 12 months compared to the CS group (-47.8% [-66.9%, -33.1%] vs. -73.5% [-89.5%, -57.0%], P = 0.005), indicating that initially, the antiproteinuric effect of HCQ  was less pronounced than the systemic CS treatment. With more prolonged follow-up at 24 months, no significant differences were found between the HCQ group and CS group in the levels of proteinuria or the percentage of reduction. Both groups maintained a stable estimated glomerular filtration rate over the 24-month study period. Overall, these findings suggest that the long-term application of HCQ has significant antiproteinuric effects and can maintain stable renal function, similar to CS. HCQ is a well-tolerated supportive treatment for IgAN patients and should be considered as an alternative for patients intolerant to CS.

Click to read the study in BMC Nephrology

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