Long-Term Effect of Oral Methylprednisolone on Kidney Outcomes in Patients with IgAN: TESTING-ON, a Post-Trial Observational Study
Bibliographic record
Abstract
Background: The Therapeutic Evaluation of STeroids in IgA Nephropathy Global (TESTING) trial reported that full and reduced doses of oral methylprednisolone can reduce the risk of a composite kidney outcome and kidney failure. Therefore, it is unclear if a reduced dose corticosteroid regimen safely improves long-term kidney outcomes and if these benefits sustained over time. We report the findings from long-term post-trial follow-up aiming to understand whether the effects persist overall and by dose (TESTING-ON, NCT05434325). Methods: We invited all surviving participants who had not reach kidney failure, previously assigned to full or reduced dose methylprednisolone or placebo, to participate in observational post-trial follow-up. The primary endpoint for this study was kidney failure or death due to kidney disease. Secondary outcomes included the composite of kidney failure, 30/40/50% decrease in eGFR and all cause death, as well as death due to kidney disease, annual eGFR decline, and time averaged proteinuria on 24-hour urine collection. Results: Of 365 eligible participants, 211 (58%) consented to participate with median total follow up of 6.4 years (Q1 5.2, Q3 8.8). The baseline characteristics were comparable to those of the 503 participants who originally underwent randomization. Overall, 93 participants in the corticosteroid arm and 109 in the placebo arm reached the primary outcome (hazard ratio 0.66, 95% confidence interval, 0.50 to 0.88; P=0.0049). The treatment effect was consistent across most secondary outcomes and all protocol-specified subgroups. The reduction of time averaged proteinuria among those who received methylprednisolone was no longer evident whilst the between group differences in annual eGFR slope remained significant throughout the post-trial period. Conclusion: The beneficial effect of oral methylprednisolone on kidney failure and related outcomes in individuals with high-risk IgA nephropathy persisted out to a median follow-up of 6.4 years. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".