Roberts Jordan E, Berbert Laura, Chang Joyce, Son Mary Beth F
Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
ACR Open Rheumatol. 2022 Nov;4(11):954-963. doi: 10.1002/acr2.11494. Epub 2022 Aug 29.
Black and Hispanic children with pediatric lupus (pSLE) have higher morbidity and mortality than non-Hispanic White children. The extent to which differences in outcomes are due to treatment disparities, including medication use, is unknown. We aimed to determine whether medication use in pSLE is associated with race and ethnicity in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry.
Patients with pSLE enrolled in the CARRA Registry from 2017 to 2020 were included. Multivariable mixed-effect logistic regression, adjusted for site of care, was used to compare use of antimalarials, high-dose oral glucocorticoids, and rituximab in Black and Hispanic children.
We identified 639 children with pSLE, of whom 480 had at least 1 year of follow-up. At enrollment, 89% of patients were prescribed an antimalarial and 50% were on high-dose glucocorticoids. Of those with 1 year of follow-up, 12% received rituximab. Nephritis, shorter disease duration, and higher Systemic Lupus Erythematosus Disease Activity Index 2000 scores were associated with high-dose glucocorticoid use. Antimalarial use was higher among those with nephritis and lower in children with no insurance. Rituximab use was associated with Black race in the fixed-effects model but not when adjusted for site of care.
We identified differences in medication use by race and insurance status. Site of care was associated with the racial differences observed in rituximab use. Further research is needed to optimize pSLE treatments particularly where use is highly variable, including glucocorticoid dosing and use of rituximab, and understand the impact of practice variation on disparities in pSLE outcomes.
患有儿童狼疮（pSLE）的黑人及西班牙裔儿童的发病率和死亡率高于非西班牙裔白人儿童。包括药物使用在内的治疗差异在多大程度上导致了这种结果差异尚不清楚。我们旨在确定儿童关节炎和风湿病研究联盟（CARRA）登记处中pSLE患者的药物使用是否与种族和民族相关。
纳入2017年至2020年在CARRA登记处登记的pSLE患者。使用多变量混合效应逻辑回归，并对治疗地点进行调整，以比较黑人和西班牙裔儿童使用抗疟药、高剂量口服糖皮质激素和利妥昔单抗的情况。
我们确定了639名pSLE儿童，其中480名至少有1年的随访时间。在入组时，89%的患者被开具了抗疟药，50%的患者使用高剂量糖皮质激素。在有1年随访的患者中，12%接受了利妥昔单抗治疗。肾炎、疾病持续时间较短以及较高的2000年系统性红斑狼疮疾病活动指数与高剂量糖皮质激素的使用相关。肾炎患者中抗疟药的使用较高，而没有保险的儿童中抗疟药的使用较低。在固定效应模型中，利妥昔单抗的使用与黑人种族相关，但在对治疗地点进行调整后则不相关。
我们发现了药物使用在种族和保险状况方面的差异。治疗地点与利妥昔单抗使用中观察到的种族差异相关。需要进一步研究以优化pSLE治疗，特别是在使用差异很大的情况下，包括糖皮质激素的剂量和利妥昔单抗的使用，并了解实践差异对pSLE结果差异的影响。
