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The aim of this study was to compare the therapeutic effects of oral glucocorticoids (GCS) combined with intravenous cyclophosphamide (CTX) and oral GCS alone in the treatment of the MPGN-IgAN patients with NS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Biopsy-proven primary IgAN patients who were aged \u226514\u00a0years at diagnosis, had coexistent NS and MPGN and estimated glomerular filtration rate (eGFR) \u226515\u00a0mL\/min\/1.73 m2, and were treated by oral GCS combined with intravenous CTX or oral GCS alone for 6\u201312\u00a0months were retrospectively included. The patients in the GCS\u00a0+\u00a0CTX (prednisone 0.6\u20130.8\u00a0mg\/kg\/day and intravenous CTX 0.6\u20131.0\u00a0g monthly) or GCS (prednisone 0.8\u20131\u00a0mg\/kg\/day) group were rather matched at a 1:1 ratio on key characteristics by propensity score matching. The primary outcome was defined as either complete remission or partial remission at Month 24. The secondary outcome was a composite renal endpoint defined as a 50% decline in eGFR, doubling of serum creatinine or progression to end-stage kidney disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 146 IgAN patients who met the inclusion criteria, 42 patients were enrolled in the GCS\u00a0+\u00a0CTX group, and 42 patients were enrolled in the GCS group after propensity score matching. The clinical and histological parameters were similar between the two groups. Remission occurred more frequently in the GCS\u00a0+\u00a0CTX group at Month 6 (88.1% vs 52.4%, P\u00a0&amp;lt;\u00a00.001), Month 12 (88.1% vs 56.1%, P\u00a0=\u00a00.001) and Month 24 (85.0% vs 47.5%, P\u00a0&amp;lt;\u00a00.001) than in the GCS group. Moreover, subgroup analysis revealed that the higher response rate at Month 24 in the GCS\u00a0+\u00a0CTX group than in the GCS group was also present in different subgroups defined by sex, age, eGFR or Oxford MEST-C. Notably, we found that eGFR decreased at a lower rate in patients from the GCS\u00a0+\u00a0CTX group than in patients from the GCS group [eGFR slope: 0.05(\u20133.09, 3.67) vs \u20132.56 (\u201311.30, 0.86) mL\/min\/1.73 m2\/year, P\u00a0=\u00a00.03]. Based on multivariate Cox regression analysis, GCS\u00a0+\u00a0CTX treatment was found to be independently associated with a decrease in risk for the composite endpoint after adjusted by the International Risk Prediction Score with race (hazard ratio\u00a0=\u00a00.17, 95% confidence interval 0.04\u20130.83, P\u00a0=\u00a0.03). There was no significant difference in adverse events (50.0% vs 42.9%, P\u00a0=\u00a00.51) or serious adverse events (7.1%\u00a0vs 11.9%, P\u00a0=\u00a0.71) between the two groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Oral GCS combined with intravenous CTX is superior to GCS alone in treating MPGN-IgAN patients combined with NS. As the retrospective design and small sample size, our findings need to be validated by a prospective study.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfad164","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T01:04:53Z","timestamp":1689296693000},"page":"2567-2577","source":"Crossref","is-referenced-by-count":6,"title":["Oral glucocorticoids with intravenous cyclophosphamide or oral glucocorticoids alone in the treatment of IgA nephropathy present with nephrotic syndrome and mesangioproliferative glomerulonephritis"],"prefix":"10.1093","volume":"16","author":[{"given":"Wen","family":"Du","sequence":"first","affiliation":[{"name":"Department of Nephrology, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine , Shanghai , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of 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