Use of renin angiotensin aldosterone system inhibitors in children with lupus and time to glucocorticoid discontinuation.
Use of renin angiotensin aldosterone system inhibitors in children with lupus and time to glucocorticoid discontinuation.
复制标题
DOI：
10.1016/j.kint.2022.04.023
复制
发表时间：
2022-08
影响因子：
19.6
通讯作者：
Wenderfer, Scott E.
中科院分区：
文献类型：
--
作者：
Chang, Joyce C.;Weiss, Pamela F.;Xiao, Rui;Atkinson, Meredith A.;Wenderfer, Scott E.
关键词：
关于系统性红斑狼疮（SLE）儿童患者使用肾素血管紧张素醛固酮系统（RAAS）抑制剂的资料很少。在这里，我们试图描述RAAS抑制剂在儿童SLE中的使用，并确定是否早期RAAS抑制剂开始与儿童狼疮肾炎事件的慢性糖皮质激素暴露的持续时间减少。对Truven MarketScan™ Medicaid和商业数据库（2013-2018）中的SLE和/或狼疮性肾炎儿童（5-18岁）进行了回顾性队列研究，并估计了RAAS抑制剂的使用情况。在偶发性肾炎病例中，我们使用竞争性风险模型和治疗加权的逆概率来估计诊断后180天内开始使用RAAS抑制剂与糖皮质激素停药时间之间的相关性，肾衰竭作为竞争性事件。在592例肾炎儿童和1407例非肾性SLE儿童中，分别有67%和15%的儿童接受过RAAS抑制剂治疗。在323例有肾炎和无肾炎的儿童中，RAAS抑制剂使用的中位持续时间分别为14个月和9个月。医疗补助登记与RAAS抑制剂使用的可能性增加独立相关，与肾炎无关。在158例偶发性肾炎病例中，早期RAAS抑制剂治疗与糖皮质激素停药率更快显著相关（校正子分布风险比1.81，95%置信区间[1.09 - 3.00]）。因此，早期开始RAAS抑制剂可能对新诊断为狼疮性肾炎的儿童有作用，而不仅仅是那些诱导治疗后出现难治性蛋白尿的儿童。因此，可以利用综合卫生系统数据来确认这些发现并优化儿科狼疮的预防治疗。
There is little data to inform use of renin angiotensin aldosterone system (RAAS) inhibitors in pediatric patients with systemic lupus erythematosus (SLE). Here, we sought to characterize RAAS inhibitor use in pediatric SLE, and determine whether early RAAS inhibitor initiation among children with incident lupus nephritis is associated with decreased duration of chronic glucocorticoid exposure. A retrospective cohort study was performed 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. Among incident nephritis cases, we used competing risk hazard models with inverse probability of treatment weighting 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. Among 592 children with nephritis and 1407 children with non-kidney SLE, 67% and 15% ever received RAAS inhibitors, respectively. 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 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, 95% confidence interval [1.09 – 3.00]). Thus, 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, integrated health systems data could be leveraged to confirm these findings and optimize adjunctive therapies in pediatric lupus.
登录
查看更多内容
影响因子：
4.7
作者：
Davis, Alaina;Chang, Joyce;Shapiro, Sarah;Klein-Gitelman, Marisa;Faerber, Jennifer;Katcoff, Hannah;Cidav, Zuleyha;Mandell, David S.;Knight, Andrea
通讯作者：
Knight, Andrea
影响因子：
2.6
作者：
Hanly, J. G.;Thompson, K.;Skedgel, C.
通讯作者：
Skedgel, C.
影响因子：
--
作者：
Houssiau, FA;Vasconcelos, C;Cervera, R
通讯作者：
Cervera, R
影响因子：
3.4
作者：
Karter, Andrew J.;Parker, Melissa M.;Selby, Joe V.
通讯作者：
Selby, Joe V.
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.