MONDAY, July 19 (HealthDay News) -- For patients with IgA nephropathy (IgAN), steroid treatment can prevent or delay loss of kidney function, but the therapy is not improved with the addition of the immunosuppressant drug azathioprine, according to a study published online July 15 in the Journal of the American Society of Nephrology.

Claudio Pozzi, M.D., of Ospedale A. Manzoni in Lecco, Italy, and colleagues randomized 207 IgAN patients with creatinine levels of 2.0 mg/dL or less and proteinuria levels of 1.0 g/d or greater to either methylprednisolone (a three-day pulse in months one, three, and five), oral prednisone (0.5 mg/kg every second day), and azathioprine (1.5 mg/kg per day for six months); or steroids only on the same schedule. The study outcomes were renal survival defined as the time to 50 percent increase in plasma creatinine and changes in proteinuria.

After a median 4.9-year follow-up, the researchers found that cumulative renal survival was 88 percent for patients receiving steroids plus azathioprine and 89 percent for patients receiving steroids only (P = 0.83). There was no difference between the groups for proteinuria, which decreased from 2.00 to 1.07 g/d on average (P < 0.001). In regression analysis, female gender, systolic blood pressure, number of antihypertensive drugs, angiotensin-converting enzyme inhibitor use, and proteinuria during follow-up were predictors of the risk of achieving renal survival. Adverse events, such as hepatotoxicity and leukopenia, were more frequent for those taking azathioprine.

"In summary, adding low-dose azathioprine to corticosteroids for six months does not provide additional benefit to patients with IgAN and may increase the risk for adverse events," the authors write.

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