Full Papers
Efficacy and safety of glucocorticoids combined with mycophenolate mofetil versus methotrexate in IgG4-related disease: a propensity score-matched retrospective cohort study
L. Liang1, X. Xu2, M. Shao3, H. Ye4
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Peking University, Beijing, China.
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Peking University, Beijing, China.
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Peking University, Beijing, China.
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Peking University, Beijing, China. yehbmu@126.com
CER20257
Full Papers
PMID: 42873693 [PubMed]
Received: 23/06/2026
Accepted : 14/09/2026
In Press: 14/10/2026
Abstract
OBJECTIVES:
To compare the efficacy and safety of glucocorticoids (GCs) plus mycophenolate mofetil (MMF) versus methotrexate (MTX) in treatment-naive patients with IgG4-related disease (IgG4-RD).
METHODS:
This retrospective cohort study included 154 treatment-naive patients with IgG4-RD. After 1:1 propensity score matching (PSM), 80 matched patients (40 per group) were analysed. Outcomes at 3, 6, and 12 months included complete response (CR), partial response (PR), overall response rate (ORR), clinical remission, treatment failure, relapse, and adverse events. False Discovery Rate (FDR) correction was applied for multiple comparisons in subgroup and repeated-measures analyses.
RESULTS:
Baseline characteristics were well balanced after matching. At 6 months, the MMF group showed higher ORR (92.5% vs. 72.5%, p=0.019) and PR (85.0% vs. 62.5%, p=0.022), although these differences did not retain significance after FDR correction (q=0.066 for both). At 12 months, MMF was superior in ORR (87.5% vs. 62.5%, p=0.010), CR (32.5% vs. 10.0%, p=0.014) and clinical remission rates (85.0% vs. 52.5%, p=0.002). Treatment failure was lower in the MMF group (2.5% vs. 25.0%, p=0.003). In the visceral subgroup, MMF yielded higher clinical remission (90.5% vs. 52.2%, p=0.005). Adverse events were more frequent in the MTX group (22.5% vs. 5.0%; unadjusted p=0.048; after FDR correction, q=0.336). Relapse rates were similar between groups.
CONCLUSIONS:
GCs plus MMF demonstrated better mid- to long-term efficacy and lower treatment failure than GCs plus MTX in this cohort, with potential benefits in patients with visceral involvement. These findings support MMF as a potential option for long-term maintenance therapy and warrant further prospective evaluation.
