Journal Article

Losartan and enalapril are comparable in reducing proteinuria in children with Alport syndrome

Massaad, Rachid, Webb, Nicholas J. A., Sisk, Christine McCrary, Lam, Chun, Wells, Thomas G., Shahinfar, Shahnaz, Gleim, Gilbert W.

2013

Overview

Background A previous subgroup analysis of a 12-week, double-blind study demonstrated that losartan significantly lowered proteinuria versus placebo and amlodipine and was well tolerated in children (1–17 years old) with proteinuria secondary to Alport syndrome. The present subgroup analysis of the open-label, extension phase of this study assessed the long-term efficacy and tolerability of losartan versus enalapril. Methods Patients who had completed the double-blind study were re-randomized to losartan or enalapril and followed for proteinuria and renal function for up to 3 years. Results Twenty-seven patients with Alport syndrome were randomized to losartan (0.44-2.23 mg/kg/day; n  = 15) or enalapril (0.07-0.72 mg/kg/day; n  = 12). The least-squares (LS) mean percent change from week 12 in urinary protein to creatinine ratio (UPr/Cr was +1.1 % in the losartan group versus a further 13.9 % reduction in the enalapril group (GMR [95 % CI] = 1.2 [0.7, 2.0]); the LS mean change from week 12 in estimated glomerular filtration rate (eGFR) was −6.4 ml/min/1.73 m 2 in the losartan group versus −9.1 ml/min/1.73 m 2 in the enalapril group. The adverse event incidence was low and comparable in both treatment groups. Conclusions In children with proteinuria secondary to Alport syndrome, losartan maintained proteinuria reduction, and enalapril produced a further proteinuria reduction over the 3-year study period. Both agents were generally well tolerated.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adolescent / Alport's syndrome / Angiotensin II Type 1 Receptor Blockers - adverse effects / Angiotensin II Type 1 Receptor Blockers - therapeutic use / Angiotensin-Converting Enzyme Inhibitors - adverse effects / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Antihypertensives / Asia / Biomarkers - urine / Blood pressure / Child / Child, Preschool / Complications and side effects / Creatinine - urine / Diabetes / Dosage and administration / Double-Blind Method / Double-blind studies / Drug therapy / Enalapril / Enalapril - adverse effects / Enalapril - therapeutic use / Enalaprilat / Europe / Female / Glomerular Filtration Rate - drug effects / Humans / Hypertension / Infant / Kidney - drug effects / Kidney - physiopathology / Kidney diseases / Least-Squares Analysis / Losartan / Losartan - adverse effects / Losartan - therapeutic use / Male / Medicine / Medicine & Public Health / Nephritis, Hereditary - complications / Nephritis, Hereditary - diagnosis / Nephritis, Hereditary - drug therapy / Nephritis, Hereditary - physiopathology / Nephritis, Hereditary - urine / Nephrology / Original Article / Pediatrics / Proteinuria / Proteinuria - diagnosis / Proteinuria - drug therapy / Proteinuria - etiology / Proteinuria - physiopathology / Proteinuria - urine / Risk factors / South America / Time Factors / Treatment Outcome / United States / Urology