Background: Hydroxychloroquine (HCQ) has shown potential in reducing proteinuria in IgA nephropathy (IgAN) and may facilitate glucocorticoid (GC) tapering, but its efficacy remains understudied.
Methods: In this retrospective cohort study, we analyzed 75 biopsy-confirmed IgAN patients treated with HCQ plus GC and 75 propensity score-matched controls receiving GC-only (2014–2023). The primary outcome was time to GC dose reduction to ≤ 5 mg/day within 6 months, with end-stage renal disease (ESRD) as a competing risk. Secondary outcomes included renal prognosis (eGFR decline, proteinuria). A Fine-Gray competing risk model assessed the association between HCQ and time to GC dose reduction (≤ 5 mg/day), with end-stage renal disease as a competing event.
Results: HCQ significantly increased the probability of tapering success (adjusted HR = 1.68, 95% CI: 1.08–2.61). The HCQ + GC group also showed improved renal outcomes, with reduced proteinuria (median reduction: 72.2% vs. 49.9%, p = 0.01).
Conclusion: HCQ accelerates GC tapering in IgAN, offering a potential steroid-sparing strategy.
Clinical trial number: Not applicable.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12882-025-04727-7.
Keywords: Glucocorticoid; Glucocorticoid reduction; Hydroxychloroquine; IgA nephropathy; Propensity score matching.