RESEARCH - ACE inhibitors delay the occurrence of renal involvement and are associated with decreased disease activity in SLE: LUMINA

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Rheumatology Advance Access published online on May 29, 2008

Rheumatology, doi:10.1093/rheumatology/ken208

Angiotensin-converting enzyme inhibitors delay the occurrence of renal

involvement and are associated with a decreased risk of disease

activity in patients with systemic lupus erythematosus—results from

LUMINA (LIX): a multiethnic US cohort

S. Durán-Barragán1, G. McGwin, Jr2,3, L. M. Vilá4, J. D. Reveille5 and

G. S. Alarcón1,2

1Department of Medicine, Division of Clinical Immunology and

Rheumatology, 2Department of Epidemiology, 3Department of Surgery,

Section of Trauma, Burns, and Critical Care, Schools of Medicine and

Public Health, The University of Alabama at Birmingham, Birmingham,

AL, 4Department of Medicine, Division of Rheumatology, The University

of Puerto Rico Medical Sciences Campus, San , PR and 5Department

of Medicine, Division of Rheumatology, The University of Texas Health

Science Center at Houston, Houston, TX, USA.

Abstract

Objective. To examine if angiotensin-converting enzyme (ACE) inhibitor

use delays the occurrence of renal involvement and decreases the risk

of disease activity in SLE patients.

Methods. SLE patients (Hispanics, African Americans and Caucasians)

from the lupus in minorities: nature vs nurture (LUMINA) cohort were

studied. Renal involvement was defined as ACR criterion and/or

biopsy-proven lupus nephritis. Time-to-renal involvement was examined

by univariable and multivariable proportional hazards regression

analyses. Disease activity was examined with a case-crossover design

and a conditional logistic regression model; in the case intervals, a

decrease in the SLAM-R score 4 points occurred but not in the control

intervals.

Results. Eighty of 378 patients (21%) were ACE inhibitor users; 298

(79%) were not. The probability of renal involvement free-survival at

10 yrs was 88.1% for users and 75.4% for non-users (P = 0.0099, log

rank test). Users developed persistent proteinuria and/or

biopsy-proven lupus nephritis (7.1%) less frequently than non-users

(22.9%), P = 0.016. By multivariable proportional hazards

regression analyses, ACE inhibitors use [hazard ratio (HR) 0.27; 95%

CI 0.09, 0.78] was associated with a longer time-to-renal involvement

occurrence whereas African American ethnicity (HR 3.31; 95% CI 1.44,

7.61) was with a shorter time. ACE inhibitor use (54/288 case and

254/1148 control intervals) was also associated with a decreased risk

of disease activity (HR 0.56; 95% CI 0.34, 0.94).

Conclusions. ACE inhibitor use delays the development of renal

involvement and associates with a decreased risk of disease activity

in SLE; corroboration of these findings in other lupus cohorts is

desirable before practice recommendations are formulated.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken208v1?papetoc

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