Comparison between hydroxychloroquine and systemic corticosteroids in IgA nephropathy: A two-year follow-up study

Abstract

Abstract Background: Hydroxychloroquine (HCQ) is recommended as a treatment for IgA nephropathy（IgAN）to control proteinuria. The long-term effects of HCQ compared to systemic corticosteroids therapy remain unclear. Methods: We conducted a retrospective case-control study at Peking University First Hospital. 39 patients with IgAN received HCQ for at least 24 months without corticosteroids (CS) or other immunosuppressive agents were included. 78 matched patients who received systemic CS therapy were selected using propensity score matching. Clinical data over a 24-month period were compared. Results: In the HCQ group, the level of proteinuria decreased from 1.72 [1.44, 2.35] to 0.97 [0.51, 1.37] g/d (-50.5 [-74.0, -3.4] %, P < 0.001) at 24 months. Significant decline of proteinuria was also found in the CS group, and the proteinuria at 24 months in CS group was lower than that in the HCQ group (0.56 [0.15, 1.05] vs. 0.97 [0.51, 1.37] g/d, P=0.030). The percent reduction in proteinuria was not statistically different between the two groups at 24 months (-63.1% [-82.3%, -15.1% vs. -50.5% [-74.0%, -3.4%], P=0.228). In addition, the decline rates of eGFR between HCQ and CS groups were comparable (-7.9% [-16.1%, 5.8%] vs. -5.8% [-15.5%, 6.4%], P=0.729). More adverse events were observed in the CS group. Conclusions: Long-term use of HCQ can maintain renal function stable with minimal side effects, though the anti-proteinuria ability is slightly weaker than systemic corticosteroids treatment. In patients who cannot tolerate corticosteroids, HCQ might be an effective and safe supportive therapy for IgAN.