Clinical Efficacy And Safety Of Iguratimod In Reducing Panel Reactive Antibody In Uremic Patients And Kidney Transplant Recipients

Objective: To evaluate the clinical efficacy and safety of Iguratimod(IGU)in reducing panel reactive antibody(PRA)in uremic patients and kidney transplant recipients.Methods: We retrospectively collected clinical data of eligible patients with positive PRA,including gender,age,transplant history,dialysis modalities,dialysis duration,pregnancy history,abortion history,transfusion history,hypertension history and diabetes history,and special clinical data for kidney transplant recipients including duration between transplantation and IGU administration,occurrence of delayed graft function,Human leukocyte antigen(HLA)mismatch,and immunosuppressive regimens.Propensity score matching(PSM)analysis was conducted to eliminate the difference between the IGU group and the non-IGU group.PRA change before and after drug treatment were assessed by Mann–Whitney U test and Wilcoxon signed rank test.Adverse events were also evaluated by Chi-squared test.Results: A total of 20 patients with kidney failure were included,17 of whom obtained 3-month PRA follow-up data.There were no significant changes in total antibodies,class I antibodies and class II antibodies after 3 months of regular administration of IGU(P >0.05).Eleven patients obtained 6-month follow-up data.After 6 months of regular medication,the total antibodies and class I antibodies were significantly decreased(P <0.05),while the class II antibodies were the same between before and after treatment(P >0.05).A total of 80 high HLA mismatched kidney transplant recipients were enrolled in the study,and 54 recipients were eventually included in the analysis after 1:1 matching analysis.Then 373 and 143 PRA sites were detected in IGU group and the control group,respectively.After IGU administrated for 9 months,significantly MFI decrease was found in total antibodies,class I antibodies,class II antibodies,class A antibodies,class B antibodies,class Cw antibodies,class DQ antibodies and class DR antibodies(P <0.05),except for class DP antibodies(P >0.05).Decrease of PRA in the IGU group was greater than in control group in total antibodies,class I antibodies,class II antibodies,class A antibodies and class DR antibodies(P <0.05),except in class B antibodies,class Cw antibodies,class DP antibodies and class DQ antibodies(P >0.05).No serious adverse events were reported,and the incidence of adverse events was comparable between two groups(P >0.05).Conclusion: PRA level was identical in patients diagnosed with uremia after 3-month IGU administration,while total antibodies and class I antibodies decreased significantly after 6 months of IGU administration.Meanwhile,PRA levels in high-mismatched kidney transplant recipients were significantly reduced after the administration of IGU.Moreover,no serious adverse reactions occurred in patients taking IGU,and highly safety of IGU was identified.