Early initiation of renin angiotensin aldosterone system (RAAS) inhibitors in children with lupus nephritis may lessen their glucocorticoid exposure, a new study finds.

Among 1999 children with systemic lupus erythematosus (SLE) in the 2013-2018 Truven MarketScan™ Medicaid and Commercial 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 RAAS inhibitor initiation was significantly associated with a 1.8-fold faster rate of glucocorticoid discontinuation compared with no RAAS inhibitor use, Joyce C. Chang, MD, MSCE, of The Children’s Hospital of Philadelphia Research Institute in Pennsylvania and colleagues reported in Kidney International. Median duration of RAAS inhibitors in children with lupus nephritis was 14 months.

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

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

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


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