HCQS and Leflunomide May Improve Renal Function and Proteinuria in IgA Nephropathy

A new study published in the Journal of Nephrology suggests that HCQS and leflunomide may improve renal function and proteinuria in IgA nephropathy.

To date, the understanding of IgA nephropathy (IgAN) pathophysiology has remained incomplete; therefore, treatment remains largely empiric, and the efficacy and safety of immunosuppressants remain controversial. We aimed to assess the efficacy and safety of hydroxychloroquine and leflunomide therapy in a retrospective cohort of patients with IgAN.

They screened the IgAN registration database in our department, and a total of 159 kidney patients with biopsy-confirmed IgAN were enrolled, with:

• 57 patients receiving hydroxychloroquine plus a renin-angiotensin system inhibitor (hydroxychloroquine group)
• 52 patients receiving leflunomide plus a renin-angiotensin system inhibitor (leflunomide group)
• 50 patients receiving only a renin-angiotensin system inhibitor (renin-angiotensin system inhibitor-only group)

Changes in proteinuria, hematuria, and the estimated glomerular filtration rate (eGFR), as well as adverse events, were analyzed during the follow-up period.

Results

At the end of the 6-month follow-up, proteinuria significantly decreased by:

• 70.36 (57.54, 79.33)% in the hydroxychloroquine group
• 57.29 (46.79, 67.29)% in the leflunomide group
• 41.20 (25.76, 48.94)% in the renin-angiotensin system inhibitor-only group

compared to baseline (all P values < 0.001). Hematuria significantly decreased by 71.07 (56.48, 82.47)% in the leflunomide group (P < 0.001). The eGFR improved by:

• 3.72 ± 2.97% in the hydroxychloroquine group
• 3.16 ± 2.00% in the leflunomide group
• 1.91 ± 2.41% in the renin-angiotensin system inhibitor-only group

but without statistical significance. No serious adverse events occurred during the follow-up period. Both hydroxychloroquine combined with a renin-angiotensin system inhibitor and leflunomide combined with a renin-angiotensin system inhibitor were more effective than a renin-angiotensin system inhibitor alone in improving proteinuria in IgAN patients. Hydroxychloroquine was more effective in reducing proteinuria, and leflunomide showed superiority in reducing hematuria. The results need to be verified in large-scale randomized controlled trials.

Reference

He WJ, Wang J, Liu N, et al. The efficacy and safety of hydroxychloroquine versus leflunomide in patients with IgA nephropathy: a single-center experience. J Nephrol. https://doi.org/10.1007/s40620-023-01839-x

Keywords

HCQS, leflunomide, renal function, proteinuria, IgA nephropathy, He WJ, Wang J, Liu N