Early use of RAAS inhibitors may benefit children with lupus nephritis

Early initiation of renin-angiotensin-aldosterone system (RAAS) inhibitors in children with lupus nephritis may reduce their exposure to glucocorticoids, a new study has found.

Of the 1,999 children with systemic lupus erythematosus (SLE) in the Truven MarketScan™ Medicaid and Commercial 2013-2018 databases, 158 were diagnosed with lupus nephritis requiring chronic steroid use. Of these, 74 (47%) were prescribed RAAS inhibitors within 180 days of diagnosis and 84 (53%) were not.

Early initiation of RAAS inhibitors was significantly associated with a 1.8 times faster rate of glucocorticoid discontinuation compared to no use of RAAS inhibitors, Joyce C. Chang, MD, MSCE, du Children’s Hospital of Philadelphia Research Institute in Pennsylvania and colleagues reported in Kidney International. The median duration of RAAS inhibitors in children with lupus nephritis was 14 months.


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“Our results provide preliminary evidence to suggest that earlier initiation of RAAS inhibitors for childhood lupus nephritis may be associated with clinically meaningful reductions in glucocorticoid use duration, which should prompt further data collection. longitudinal studies to better understand this association and inform future directions regarding optimal treatment timing of RAAS inhibitor use,” Dr. Chang’s team wrote.

Among children with SLE but without lupus nephritis, 15% received RAAS inhibitors, primarily to treat hypertension.

Disclosure: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original reference for a full list of author disclosures.

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 discontinuation of glucocorticoids. Kidney Int. Published online May 23, 2022. doi:10.1016/j.kint.2022.04.023

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