Hydroxychloroquine reduces proteinuria in Indian patients wi
Initial supportive treatment of IgA nephropathy (IgAN) comprises of salt restriction, renin angiotensin (RAS) blockade and blood pressure control. KDIGO guidelines suggest hydroxychloroquine, an anti-malarial agent with immunomodulatory effects may be used in Chinese patients but there is paucity of data in other ethnicities. Hydroxychloroquine is widely used in treatment of autoimmune diseases. Its inhibitory effect on toll like receptors (TLR) has generated interest as TLR-9 has been implicated in pathogenesis of IgAN.

38 patients with primary IgAN having persistent proteinuria >1g/day despite supportive treatment had received HCQ for 6 months. One patient had discontinued treatment immediately due to persistent gastritis and 37 cases were analyzed. Mean eGFR was 74.7± 27.4 ml/min/1.73m2 and proteinuria was 2.1±0.8g/day. 21/37(56.8%) patients achieved remission of proteinuria (complete remission- 10, partial remission-11) after 6 months of HCQ treatment. None had >40% decline in eGFR or progression to end stage renal failure. Those who achieved remission had higher proteinuria than non-responders though not statistically significant (2.5±0.9g/day vs 1.8±0.4g/day respectively). In a randomized controlled trial in Chinese patients HCQ was significantly superior to placebo in reducing proteinuria(p<0.001). In a systematic review, HCQ was more effective in reducing proteinuria compared to supportive treatment but not compared to immunosuppression. Eight patients (21.6%) in our cohort relapsed following discontinuation of HCQ during a median follow up of 22.0(7.4,27.6) months; four achieved remission after restarting HCQ while three had persistent proteinuria.

Thus, HCQ can be considered for supportive management of IgAN in those who do not respond to RAS blockade before prescribing immunosuppression. It is inexpensive, well tolerated and not associated with increased incidence of infections. The risk of relapse suggests that longer duration of treatment may be warranted as is done in lupus nephritis.

Source: https://www.kireports.org/article/S2468-0249(22)01363-8/fulltext?rss=yes