Pediatric Nephrology

, Volume 28, Issue 5, pp 737–743

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

  • Nicholas J. A. Webb
  • Shahnaz Shahinfar
  • Thomas G. Wells
  • Rachid Massaad
  • Gilbert W. Gleim
  • Christine McCrary Sisk
  • Chun Lam
Original Article
  • 809 Downloads

Abstract

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 m2 in the losartan group versus −9.1 ml/min/1.73 m2 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.

Keywords

Alport syndrome Children Chronic kidney disease Clinical trial Enalapril Glomerular filtration rate Losartan Pediatric Proteinuria 

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Copyright information

© IPNA 2012

Authors and Affiliations

  • Nicholas J. A. Webb
    • 1
  • Shahnaz Shahinfar
    • 2
    • 3
  • Thomas G. Wells
    • 4
  • Rachid Massaad
    • 5
  • Gilbert W. Gleim
    • 6
  • Christine McCrary Sisk
    • 6
  • Chun Lam
    • 6
  1. 1.Department of Paediatric Nephrology and Wellcome Trust Children’s Clinical Research Facility, Manchester Academic Health Science Centre, Royal Manchester Children’s HospitalThe University of ManchesterManchesterUK
  2. 2.S. Shahinfar Consulting Inc.Newtown SquareUSA
  3. 3.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Arkansas Children’s HospitalThe University of Arkansas for Medical SciencesLittle RockUSA
  5. 5.MSD BelgiumBrusselsBelgium
  6. 6.Merck Sharp & Dohme CorpWhitehouse StationUSA

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