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Corticosteroids in the treatment of IgA nephropathy: lessons from the TESTING trial

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Abstract

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis, is mainly observed in young adults and children. Clinical and basic studies indicate the role of immunity in IgAN pathogenesis; however, corticosteroid therapy has been controversial in past decades. The TESTING study, initiated in 2012, is an international, multicenter, double-blinded, randomized, placebo-controlled trial that aimed to evaluate oral methylprednisolone’s safety and long-term efficacy under conditions of optimized supportive treatment in patients with IgAN whose risk of progression is high. After a decade of effort, the successful completion of the TESTING study showed that a 6- to 9-month course of oral methylprednisolone is an effective regimen to protect kidney function in high-risk patients with IgAN, but also demonstrated safety concerns. Compared with the full-dose regimen, the reduced-dose regimen was reported to be beneficial, with successfully increased safety. Overall, the TESTING trial provided more data regarding the treatment dosage and safety of corticosteroids, a cost-effective therapy, in IgAN, which have important implications for pediatric patients with IgAN. With a deeper understanding of the disease pathogenesis of IgAN, ongoing studies of novel therapeutic regimens would help further optimize the benefit-risk ratio.

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Funding

This work was supported by grants from the National Natural Science Foundation of China (grant numbers 82170711 and 82070733); the Beijing Nova Program, Peking University Medicine Seed Fund for Interdisciplinary Research (grant number BMU2022MX025); the Fundamental Research Funds for Central Universities and the “PRO•Run” Fund of the Nephrology Group of CEBM (grant number KYS2021-03–02-16); the National High-Level Hospital Clinical Research Funding (grant number 2022CR81); and the Fundamental Research Funds for the Central Universities, CAMS Innovation Fund for Medical Sciences (grant number 2019-I2M-5–046).

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  1. Yuemiao Zhang and Yi-Tong Hu equally contributed to this study.

Authors and Affiliations

  1. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People’s Republic of China

    Yuemiao Zhang, Yi-Tong Hu, Ji-Cheng Lv & Hong Zhang

  2. Peking University Health Science Center, Xue Yuan Road 38, Beijing, 100191, People’s Republic of China

    Yi-Tong Hu

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Zhang, Y., Hu, YT., Lv, JC. et al. Corticosteroids in the treatment of IgA nephropathy: lessons from the TESTING trial. Pediatr Nephrol 38, 3211–3220 (2023). https://doi.org/10.1007/s00467-023-05919-9

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