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Dosing and duration of glucocorticoid therapy for adult patients with IgA nephropathy

Dosing and duration of glucocorticoid therapy for adult patients with IgA nephropathy
Glucocorticoid Initial dose Duration of initial dose Taper Total glucocorticoid exposure Reference
Methylprednisolone 0.4 mg/kg orally once daily (rounded to nearest 4 mg; maximum dose: 32 mg/day) 2 months Reduce daily dose by 4 mg every month for 4 months 6 months TESTING 2022[1]
Methylprednisolone 0.6 to 0.8 mg/kg orally once daily (rounded to nearest 4 mg; maximum dose: 48 mg/day) 2 months Reduce daily dose by 8 mg every month for 4 months 6 months TESTING 2017[2]
Prednisone 1 mg/kg orally per day (maximum dose: 75 mg/day) 2 months Reduce daily dose by 0.2 mg/kg every month for 4 months 6 months Manno et al.[3]
Prednisone 0.8 to 1 mg/kg orally per day 2 months Reduce daily dose by 5 to 10 mg every 2 weeks for 4 months 6 months Lv et al.[4]

Methylprednisolone (IV)

and

Prednisolone/prednisone (oral)

Methylprednisolone 1 g IV for 3 days at the start of months 1, 3, and 5

and

Prednisolone[4] or prednisone[5] 0.5 mg/kg orally every other day on remaining days 		6 months None 6 months

Pozzi et al.[5]

Rauen et al.[6]
Targeted-release formulation of budesonide (TRF-budesonide) 16 mg orally daily 9 months Reduce dose to 8 mg once daily for 2 weeks, then discontinue 9 months Fellström et al.[7,8]
This table describes glucocorticoid regimens used for IgA nephropathy in various clinical trials. For further discussion refer to the UpToDate clinical topic review of treatment of IgA nephropathy.
IgA: immunoglobulin A; IV: intravenously.
References:
  1. Lv J, Wong MG, Hladunewich MA, et al. Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: The TESTING randomized clinical trial. JAMA 2022; 327:1888.
  2. Lv J, Zhang H, Wong MG, et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: The TESTING randomized clinical trial. JAMA 2017; 318:432.
  3. Manno C, Torres DD, Rossini M, et al. Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transplant 2009; 24:3694.
  4. Lv J, Zhang H, Chen Y, et al. Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: A randomized controlled trial. Am J Kidney Dis 2009; 53:26.
  5. Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: A randomised controlled trial. Lancet 1999; 353:883.
  6. Rauen T, Eitner F, Fitzner C, et al. Intensive supportive care plus immunosuppression in IgA nephropathy. N Engl J Med 2015; 373:2225.
  7. Fellström BC, Barratt J, Cook H, et al. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial. Lancet 2017; 389:2117.
  8. TARPEYO [package insert]. Stockholm, Sweden: Calliditas Therapeutics AB; 2021. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215935s000lbl.pdf (Accessed on June 15, 2022).
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