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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Although the efficacy of low-dose corticosteroids (CS) combined with mycophenolate mofetil (MMF) in treating IgA nephropathy (IgAN) has been established, safety remains a concern. Whether the regimen of low-dose, short-course CS combined with delayed MMF initiation can reduce adverse events while maintaining good efficacy remains elusive.
This multi-center, retrospective study included 160 adults with biopsy-proven IgAN in Jiangxi Province, China (Jan 2022-Jun 2023), with a follow-up period of 18 months. Key inclusion criteria were persistent urinary protein (UP) ≥ 0.75 g/day despite renin-angiotensin system blockade for 1-month and estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73m². Patients were assigned to two groups: the delayed MMF group (n=79) received low-dose, short-course CS (a total of three months, initially 0.4-0.6 mg/kg/day, reducing by 20% every two weeks, and maintained at 0.1 mg/kg/day), with MMF (1.25-1.5 g/day for six months and subsequently maintained at 0.75-1.0 g/day until follow-up finished) introduced only when the CS dose reached 0.2-0.3 mg/kg/day; the Recommended MMF group (n=81) started both CS and MMF initiated concurrently from the outset, following the same dosing and tapering schedules as above. Propensity score matching (PSM, 1:1, caliper=0.2) adjusted for age, gender, eGFR, UP, and MESTC score, yielding 63 balanced pairs.
After PSM, both groups showed comparable clinical and pathological characteristics (all P >0.05, Table 1). Efficacy outcomes were not significantly different (Table 2). Specifically, the CR rates at 6, 12, and 18 months were similar (at 6-month: 30.2% vs. 28.6%, P = 0.845; at 12-month: 44.4% vs. 39.7%, P = 0.588; at 18-month: 57.7% vs. 57.1%, P = 0.875). The OR rates at 6, 12, and 18 months were also comparable (at 6-month: 58.7% vs. 50.8%, P = 0.371; at 12-month: 77.8% vs. 74.6%, P = 0.676; at 18-month: 81.0% vs. 81.0%, P = 1.000, Table 2). Kaplan-Meier analyses confirmed no difference in cumulative CR (P = 0.730, Figure 2B), OR (P = 0.630, Figure 2D), or composite event-free survival (P = 0.640, Figure 2F).
Subgroup analyses across key baseline characteristics generally revealed no significant interactions between treatment assignment and most subgroups, except for T. T1 was associated with HR = 1.54 (95% CI: 0.79-3.00). A significant interaction was observed (P = 0.003). Furthermore, longitudinal data revealed comparable improvements in UP, ALB, and eGFR between both groups over the 18-month follow-up, with no significant intergroup differences (P = 0.835 for UP, P = 0.922 for ALB, P = 0.051 for eGFR; Figure 4). Multivariable Cox regression confirmed that the treatment group was not associated with CR (HR 0.86, 95% CI 0.55-1.34, P = 0.513, Table 3). Regarding Safety, the Delayed MMF group had a significantly lower incidence of total AEs (44.4% vs 63.5%, P = 0.032) and notably fewer infections (28.6% vs 50.8%, P = 0.011, Table 4).
The regimen of low-dose, short-course CS with delayed MMF initiation demonstrates similar efficacy as the recommended immediate MMF regimen, significantly alleviating the burden of adverse events and lowering the risk of infections for IgAN patients.
