Association of Race and Ethnicity With Medication Use for Pediatric Lupus in the Childhood Arthritis and Rheumatology Research Alliance Registry

Abstract

Objective 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. Methods 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. Results 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. Conclusion 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.