Efficacy and Safety of High-Dose versus Low-dose methylprednisolone pulse therapy for IgA vasculitis Nephritis: a retrospective observational study

Abstract Objective To investigate the clinical efficacy and safety of two different dosage of methylprednisolone pulse therapy in children with IgAVN presenting with crescent formation involving less than 50% of glomeruli. Methods Based on the glucocorticoid dosage, 122 pediatric patients diagnosed with IgAVN were divided into high-dose group and low-dose(reduced-dose/mini-dose) group. Clinical efficacy, immunological parameters, and incidences of adverse reactions were compared. Results At 1 and 3 months, the CR rates of high-dose group and low-dose group were 9.2% vs 0.0% and 44.7% vs 26.1%, respectively, with statistically significant differences(P < 0.05). At 6 and 12 months, the CR rates were 71.1% vs 67.4% and 93.4% vs 93.5%, showing no statistically significant differences respectively(P > 0.05). The ORR at 1 and 3 months were 70.4% vs 32.4% and 85.5% vs 54.3%. At 6 and 12 months, the ORR were 93.4% vs 91.3% and 97.4% vs 97.8%, with no significant differences respectively. In both groups, 24h UTP and URBC decreased significantly, while serum albumin levels increased markedly at all post-treatment time compared with baseline. Intergroup differences were statistically significant at 1 and 3 months but not at 6 and 12 months. The incidences of all adverse reactions were significantly higher in the high-dose group than low group. Conclusion The high-dose group demonstrated superior efficacy to the low group at 1 and 3 months after treatment, whereas comparable efficacy was observed at 6 and 12 months. The high-dose group showed significantly higher rates of infection and other adverse reactions compared with low group.