Therapeutic Evaluation of Steroids in IgA Nephropathy Global Study (TESTING Low Dose Study) (TESTING)
IgA Glomerulonephritis
About this trial
This is an interventional treatment trial for IgA Glomerulonephritis focused on measuring end stage kidney disease, IgA nephropathy
Eligibility Criteria
Inclusion Criteria:
- IgA nephropathy proven on renal biopsy.
- Proteinuria: >=1.0g/day while receiving maximum tolerated dose of RAS blockade following the recommended treatment guidelines of each country where the trial is conducted.
- eGFR: 30 to 120ml/min per 1.73m²(inclusive) while receiving maximum tolerated RAS blockade
Exclusion Criteria:
Indication for immunosuppressive therapy with corticosteroids, such as:
- Minimal change renal disease with IgA deposits Crescents present in >50% of glomeruli on a renal biopsy within the last 12 months.
Contraindication to immunosuppressive therapy with corticosteroids, including:
- Active infection, including HBV infection or clinical evidence of latent or active tuberculosis (nodules, cavities, tuberculoma, etc)
- Malignancy within the last 5 years, excluding treated non-melanoma skin cancers (ie. squamous or basal cell carcinoma)
- Current or planned pregnancy or breastfeeding women of childbearing age who are not able or willing to use adequate contraception.
- Systemic immunosuppressive therapy in the previous year.
- Malignant /uncontrolled hypertension (>160mm systolic or 110mmHg diastolic)
- Current unstable kidney function for other reasons, e.g. macrohaematuria induced acute kidney injury
- Age <18 years old
- Secondary IgA nephropathy: e.g. due to lupus, liver cirrhosis, Henoch- Schonlein purpura
- Patients who are unlikely to comply with the study protocol in the view of the treating physician.
Sites / Locations
- Concord Repatriation and General Hospital
- Nepean Hospital
- Royal North Shore Hospital
- Royal Adelaide Hospital
- Royal Melbourne Hospital
- University of Calgary/Alberta Health Services
- University of Alberta Hospitals
- St Pauls Hospital
- St. Joseph's Healthcare
- London Health Sciences Centre
- Sunnybrook Health Sciences Centre
- Toronto General Hospital,
- Hôpital Maisonneuve-Rosemont
- Chinese PLA General Hospital (301 Hospital)
- The First Affiliated Hospital, Sun Yat-Sen University
- Guangdong Provincial People's Hospital, Guangzhou
- Peking University Shenzhen Hospital
- The Second Hospital of Hebei Medical University
- The Third Hospital of Hebei Medical University
- The First Affiliated Hospital of Henan University of Science &Technology
- Henan Provincial People's Hospital
- The First Affiliated Hospital of Zhengzhou University
- ongji Hospital, Tongji Medical College, Huazhong University of Science & Technology
- Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology
- Renmin Hospital, Wuhan University
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology,
- Inner Mongolia People's Hospital
- General Hospital of Eastern Theater Command
- The First Affiliated Hospital with Nanjing Medical University
- Jilin Province FAW General Hospital [Jilin University Fourth Hospital]
- he First Affiliated Hospital of Dalian Medical University, Dalian
- Shengjing Hospital Of China Medical University
- Qilu Hospital of Shandong University
- The First Affiliated Hospital of Shangdong First Medical University,Shangdong Provincial Qianfoshin
- Shandong Provincial Hospital
- Jinan Military General Hospital
- Yantai Yuhuangding Hospital
- he Second Hospital of Shanxi Medical University, Taiyuan
- West China Hospital of Sichuan University
- Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital
- The First Affiliated Hospital, Zhejiang University of Medicine
- Hangzhou Hospital of Traditional Chinese Medicine,
- Ningbo Urology & Nephrology Hospital
- Zhejiang Provincial People's Hospital
- Beijing Anzhen Hospital, Capital Medical University
- Peking University First Hospital
- Peking University People's Hospital
- Beijing Hospital
- Peking University Third Hospital
- XinQiao Hospital, Third Military Medical University
- Renji Hospital, Shanghai Jiaotong University School of Medicine
- Ruijin Hospital, Shanghai Jiaotong University, School of Medicine
- Huashan Hospital, Medical Centre of Fudan University
- Princess Margaret Hospital
- Osmania General Hospital
- Nizam's Institute of Medical Science
- Calicut Medical College
- Post Graduate Institue of Medical Education and Reasearch
- Madras Medical College
- Sanjay Gandhi Post Graduate Institute of Medical Science
- Hospital Sultanah Aminah
- Hospital Kuala Lumpur
- Hospital Tuanku Jaafar Seremban
- Hospital Raja Permaisuri Bainun
- Hospital Umum Sarawak
- University Malaysia Medical Centre
Arms of the Study
Arm 1
Arm 2
Active Comparator
Placebo Comparator
oral methylprednisolone
placebo
oral methylprednisolone Original Cohort: Methylprednisolone group; start at 0.8mg/kg/day with a maximal 48mg/kg/day x 2months, taper by 8mg/day every month with optimal blood pressure control and full dose of ACE inhibitors or ARBs as recommended by guidelines. Low Dose Cohort: Methylprednisolone group; start at 0.4mg /kg/day with a maximal dose of 32mg/day and a minimum dose of 24mg/day, reducing over 6-9months. All participants will also receive standard guideline based care, without steroid therapy. Prophylactic trimethoprim/sulfamethoxazole (a single strength tablet daily or half a double strength tablet daily) will be used during the first 3 months in the low-dose cohort, after randomisation, for the prevention of severe PJP infection, unless there is a documented sulfa allergy.
Original Cohort: Matching placebo; Optimal blood pressure control and full dose of ACE inhibitors or ARBs as recommended by guidelines; Low Dose Cohort; Matching placebo: Optimal blood pressure control and full dose of ACE inhibitors or ARBs as recommended by guidelines. All participants will also receive standard guideline based care, without steroid therapy. Prophylactic trimethoprim/sulfamethoxazole (a single strength tablet daily or half a double strength tablet daily) will be used during the first 3 months in the low-dose cohort, after randomisation, for the prevention of severe PJP infection, unless there is a documented sulfa allergy