Therapeutic effects of leflunomide combined with methylprednisolone in patients with IgA nephropathy

doi:10.3877/cma.j.issn.2095-3216.2020.03.002

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of leflunomide combined with methylprednisolone in the treatment of IgA nephropathy.

Methods

75 patients with IgA nephropathy admitted to the Department of Nephrology of the Chinese PLA General Hospital from December 2008 to October 2016 were recruited, and randomly divided into two groups: the MMF group (mycophenolate mofetil combined with methylprednisolone, 44 cases), and the LEF group (leflunomide combined with methylprednisolone, 31 cases). There were no significant differences in baseline data between the two groups (P>0.05).

Results

After 2, 6, and 10 months of treatment, 24 h proteinuria of the patients was significantly reduced and the serum albumin level was improved, while there were no significant differences between the two groups in remission rate (20.45% vs 29.03%, 70.45% vs 77.42%, 72.73% vs 83.87%, respectively), complete remission rate (9.09% vs 6.45%, 38.64% vs 45.16%, 40.91% vs 48.39%, respectively), 24 h proteinuria, serum albumin, creatinine, recurrence rate [9.09% (4 cases) vs 3.23% (1 case)], and adverse reactions [13.64% (6 cases) vs 12.9% (4 cases)] (all P>0.05).

Conclusion

Leflunomide combined with methylprednisolone had the same efficacy as mycophenolate mofetil combined with methylprednisolone, and was one of the safe and effective solutions for the treatment of IgA nephropathy.

Key words: IgA nephropathy, Leflunomide, Therapeutic effect

Yu Dong, Shunlai Shang, Qinggang Li, Xiangmei Chen. Therapeutic effects of leflunomide combined with methylprednisolone in patients with IgA nephropathy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2020, 09(03): 102-106.

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Figures/Tables 7

References 23

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项目	MMF组(n＝44)	LEF组(n＝31)	检验统计量值	P值
年龄^a	38.50(17.76)	40.00(20.00)	－0.718	0.475
性别(男/女)	26/18	13/18	2.144	0.143
身体质量指数^a	26.40(5.87)	26.10(4.50)	－1.005	0.291
平均动脉压(mmHg)^b	97.73±9.10	96.04±5.67	0.991	0.325
尿蛋白定量(g/24 h)^a	3.57(2.23)	3.56(2.14)	－0.516	0.606
血清白蛋白(g/L)^b	31.46±5.66	32.50±5.37	0.806	0.423
肌酐(μmol/L)^a	93.03(17.23)	92.60(30.70)	－0.807	0.420
尿素(mmol/L)^a	8.49(6.17)	7.13(6.62)	－1.372	0.170
尿酸(μmol/L)^a	403.60(160.02)	327.70(159.6)	－1.786	0.074
谷氨酸氨基转移酶(U/L)^a	19.30(14.85)	18.70(14.50)	－0.576	0.565
天冬氨酸氨基转移酶(U/L)^a	15.40(9.90)	14.00(5.50)	－1.173	0.241
Lee氏分级(Ⅲ/Ⅳ/Ⅴ)	13/21/10	9/13/9	0.422	0.810
甲泼尼龙剂量(mg)^a	40.00(5.00)	35.00(10.00)	－1.651	0.099
ACEI或ARB等类药物/非ARB、ACEI等类药物	17/27	9/22	0.741	0.389

项目	MMF组(n＝44)	LEF组(n＝31)	检验统计量值	P值
年龄^a	38.50(17.76)	40.00(20.00)	－0.718	0.475
性别(男/女)	26/18	13/18	2.144	0.143
身体质量指数^a	26.40(5.87)	26.10(4.50)	－1.005	0.291
平均动脉压(mmHg)^b	97.73±9.10	96.04±5.67	0.991	0.325
尿蛋白定量(g/24 h)^a	3.57(2.23)	3.56(2.14)	－0.516	0.606
血清白蛋白(g/L)^b	31.46±5.66	32.50±5.37	0.806	0.423
肌酐(μmol/L)^a	93.03(17.23)	92.60(30.70)	－0.807	0.420
尿素(mmol/L)^a	8.49(6.17)	7.13(6.62)	－1.372	0.170
尿酸(μmol/L)^a	403.60(160.02)	327.70(159.6)	－1.786	0.074
谷氨酸氨基转移酶(U/L)^a	19.30(14.85)	18.70(14.50)	－0.576	0.565
天冬氨酸氨基转移酶(U/L)^a	15.40(9.90)	14.00(5.50)	－1.173	0.241
Lee氏分级(Ⅲ/Ⅳ/Ⅴ)	13/21/10	9/13/9	0.422	0.810
甲泼尼龙剂量(mg)^a	40.00(5.00)	35.00(10.00)	－1.651	0.099
ACEI或ARB等类药物/非ARB、ACEI等类药物	17/27	9/22	0.741	0.389

指标	OR(95%CI)	Wald χ²	P值
年龄(岁)	1.004(0.955～1.056)	0.022	0.883
性别(男/女)	1.330(0.358～4.938)	0.181	0.670
血清白蛋白(g/L)	0.963(0.858～1.080)	0.424	0.515
平均动脉压(mmHg)	1.050(0.971～1.135)	1.500	0.221
治疗方案(MMF/LEF)	0.625(0.163～2.398)	0.470	0.493

指标	OR(95%CI)	Wald χ²	P值
年龄(岁)	1.004(0.955～1.056)	0.022	0.883
性别(男/女)	1.330(0.358～4.938)	0.181	0.670
血清白蛋白(g/L)	0.963(0.858～1.080)	0.424	0.515
平均动脉压(mmHg)	1.050(0.971～1.135)	1.500	0.221
治疗方案(MMF/LEF)	0.625(0.163～2.398)	0.470	0.493

时间(月)	完全缓解				完全缓解＋部分缓解
时间(月)	MMF组	LEF组	χ²值	P值	MMF组	LEF组	χ²值	P值
第2月	4(9.09%)	2(6.45%)	0.000	1.000	9(20.45%)	9(29.03%)	0.734	0.392
第6月	17(38.64%)	14(45.16%)	0.319	0.572	31(70.45%)	24(77.42%)	0.451	0.502
第10月	18(40.91%)	15(48.39%)	0.413	0.521	32(72.73%)	26(83.87%)	1.288	0.256

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