Abstract: FR-OR55
Optimizing IgAN Treatment: Comparing Prednisone and Budesonide Efficacy and Safety
Session Information
- IgA Nephropathy: New Therapies and Insights
October 25, 2024 | Location: Room 6D, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Lohana, Abhi, Camden Clark Medical Center, Parkersburg, West Virginia, United States
- Akbar, Usman, Camden Clark Medical Center, Parkersburg, West Virginia, United States
- Shah, Syed Adil Mir, Dow Medical College, Karachi, Pakistan
- Shafique, Nouman, Nishtar Medical College and Hospital, Multan, Punjab, Pakistan
- Muhibullah, Fnu, Camden Clark Medical Center, Parkersburg, West Virginia, United States
- Muddana, Neeharika, Camden Clark Medical Center, Parkersburg, West Virginia, United States
Background
IgA nephropathy (IgAN) is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 antibodies originating from the intestinal mucosal lymphoid tissue. It is one of the most common causes of chronic kidney disease worldwide, with 20-40% of patients progressing to end-stage renal disease (ESRD). According to the KDIGO guidelines, steroids, including prednisone, are recommended for patients with persistent proteinuria despite optimal conservative care. Recently, budesonide, a targeted steroid, was introduced, focusing on the gut-associated lymphoid tissue to reduce the production of IgA1. This study compares the efficacy of budesonide in the treatment of IgAN to prednisone.
Methods
We utilized the US collaborative Network database to identify patients aged 18 and above diagnosed with IgAN who received either budesonide or prednisone. Patients were characterized and matched based on propensity scores using current ICD terminology codes. Each cohort comprised 1330 patients.
Results
In comparative analysis, mortality was lower in the prednisone cohort (4.3% vs. 6.2%, risk difference -1.9%, p=0.030). However, the incidence of ESRD was significantly higher in the prednisone group (13.4% vs. 5.0%, risk difference 8.3%, p<0.001). Hematuria was more common in the prednisone cohort (12.7% vs. 9.6%, risk difference 3.1%, p=0.038), whereas microalbuminuria showed no significant difference (0.8% in both cohorts, p=0.996). Osteoporosis rates (2.8% vs. 2.4%, p=0.541), and fungal infection rates (2.4% in both cohorts, p=0.990) were similar. Proteinuria was higher in the prednisone group (35.0% vs. 25.3%, risk difference 9.7%, p=0.003). These results indicate significant differences in mortality, ESRD, hematuria, and proteinuria between the groups.
Conclusion
This study reveals that while both prednisone and budesonide are effective in managing IgAN, budesonide offers a more favourable safety profile with significantly lower rates of ESRD and proteinuria. These findings support the use of budesonide as a viable and superior alternative to prednisone for the long-term management of IgA nephropathy.