Early RAAS initiation beneficial for children with lupus nephritis: Study
USA: Early initiation of renin-angiotensin-aldosterone system (RAAS) inhibitors in pediatric patients with lupus nephritis may reduce their glucocorticoid exposure, says a new study published in Kidney International.
Not much data is available to inform the use of RASS inhibitors in children with systemic lupus erythematosus (SLE). Therefore, Joyce C. Chang, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA, and colleagues sought to characterize the use of RAAS inhibitors in pediatric SLE and determine whether early initiation of RAAS inhibitors among children with incident lupus nephritis decreases the duration of chronic glucocorticoid exposure.
For this purpose, the researchers performed a retrospective cohort study of children (ages 5-18) with SLE and/or lupus nephritis in the Truven MarketScan Medicaid and Commercial databases (2013-2018) and estimated RAAS inhibitor use. Competing risk hazard models with inverse probability of treatment weighting were used among incident nephritis cases to estimate the association between RAAS inhibitor initiation less than 180 days after diagnosis and time to glucocorticoid discontinuation with kidney failure as a competing event.
The findings of the study were as follows:
- Among 592 children with nephritis and 1407 children with non-kidney SLE, 67% and 15% ever received RAAS inhibitors, respectively.
- The median duration of RAAS inhibitor use among 323 incident users was 14 and 9 months in children with and without nephritis, respectively.
- Medicaid enrollment was independently associated with a greater likelihood of RAAS inhibitor use, irrespective of nephritis.
- Among 158 incident nephritis cases, early RAAS inhibitor initiation was significantly associated with a faster rate of glucocorticoid discontinuation (adjusted sub-distribution hazard ratio 1.81).
Based on the findings, the authors conclude, "early initiation of RAAS inhibitors may have a role in children newly diagnosed with lupus nephritis; not only those with refractory proteinuria after induction therapy." Hence, leveraging of integrated health systems data could be done to confirm these findings and optimize adjunctive therapies in pediatric lupus."
Reference:
Chang JC, Weiss PF, Xiao R, Atkinson MA, Wenderfer SE. Use of renin angiotensin aldosterone system inhibitors in children with lupus and time to glucocorticoid discontinuation. Kidney Int. Published online May 23, 2022. doi:10.1016/j.kint.2022.04.023
