皮明婧, 袁静, 刘璐, 何平红, 胡杉杉, 查艳. 糖皮质激素治疗IgA肾病:来自IgA肾病激素治疗评估的全球研究临床试验的经验[J]. 临床肾脏病杂志, 2024, 24(5): 406-411. DOI: 10.3969/j.issn.1671-2390.2024.05.009
    引用本文: 皮明婧, 袁静, 刘璐, 何平红, 胡杉杉, 查艳. 糖皮质激素治疗IgA肾病:来自IgA肾病激素治疗评估的全球研究临床试验的经验[J]. 临床肾脏病杂志, 2024, 24(5): 406-411. DOI: 10.3969/j.issn.1671-2390.2024.05.009
    Pi Ming-jing, Yuan Jing, Liu Lu, He Ping-hong, Hu Shan-shan, Zha Yan. Corticosteroids in the treatment of IgA nephropathy: what do we learn from the TESTING trial[J]. Journal of Clinical Nephrology, 2024, 24(5): 406-411. DOI: 10.3969/j.issn.1671-2390.2024.05.009
    Citation: Pi Ming-jing, Yuan Jing, Liu Lu, He Ping-hong, Hu Shan-shan, Zha Yan. Corticosteroids in the treatment of IgA nephropathy: what do we learn from the TESTING trial[J]. Journal of Clinical Nephrology, 2024, 24(5): 406-411. DOI: 10.3969/j.issn.1671-2390.2024.05.009

    糖皮质激素治疗IgA肾病:来自IgA肾病激素治疗评估的全球研究临床试验的经验

    Corticosteroids in the treatment of IgA nephropathy: what do we learn from the TESTING trial

    • 摘要: 原发性IgA肾病(IgA nephropathy,IgAN)是一种常见的肾小球疾病,是导致肾功能衰竭的重要原因,主要见于青年人和儿童。在过去的几十年里,糖皮质激素疗法一直备受争议。IgA肾病激素治疗评估的全球研究(the therapeutic effects of steroids in IgA nephropathy global,TESTING)始于2012年,是一项国际性、多中心、双盲、随机、安慰剂对照试验,旨在评估在优化支持治疗条件下口服甲泼尼龙治疗进展风险高的IgAN患者的安全性和长期疗效。经过十年的努力,这项研究的成功完成表明,6~9个月的口服甲泼尼龙是保护IgAN高危患者肾功能的有效方案,但也显示出安全问题。TESTING研究发现,与全剂量甲泼尼龙方案相比,减少剂量的甲泼尼龙方案是有益的,且剂量的减少有助于提高甲泼尼龙的使用安全性。总的来说,TESTING研究提供了更多关于IgAN中糖皮质激素治疗剂量和安全性的数据。TESTING研究结果给患有IgAN的患儿提供了重要的启示。随着对IgAN发病机制的深入了解,正在进行的新治疗方案的研究将有助于进一步优化IgAN治疗的获益-风险比。

       

      Abstract: IgA nephropathy (IgAN), the most common form of primary glomerulonephritis, is predominant in young adults and children. Corticosteroid therapy has been controversial over several past decades. TESTING (Therapeutic Effects of Steroids in IgA Nephropathy Global) study, initiated in 2012, is an international, multicenter, double-blinded, randomized and placebo-controlled trial for evaluating oral methylprednisolone’s safety and long-term efficacy under conditions of optimized supportive treatment in IgAN patients at an elevated risk of progression. After one decade of efforts, successful completion of TESTING indicated that a 6 to 9 month course of oral methylprednisolone has been an effective regimen of protecting kidney function in high-risk IgAN patients. Some safety concerns persisted. Compared with a full-dose regimen, reduced-dose regimen was beneficial with higher safety. Overall, the TESTING trial provided more robust data regarding the treatment dosage and safety of corticosteroids. It has important implications for IgAN children. With a deeper pathogenetic understanding of IgAN, ongoing studies of novel therapeutic regimens shall further optimize the benefit-risk ratio.

       

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