Association between organ damage and mortality in systemic lupus erythematosus: a systematic review and meta-analysis

Abstract

ObjectiveAt least half of patients with systemic lupus erythematosus (SLE) develop organ damage as a consequence of autoimmune disease or long-term therapeutic steroid use. This study synthesised evidence on the association between organ damage and mortality in patients with SLE.DesignSystematic review and meta-analysis.MethodsElectronic searches were performed in PubMed, Embase, Cochrane Library and Latin American and Caribbean Health Sciences Literature for observational (cohort, case-control and cross-sectional) studies published between January 2000 and February 2017. Included studies reported HRs or ORs on the association between organ damage (measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score) and mortality. Study quality was assessed using the modified Newcastle-Ottawa assessment. Pooled HRs were obtained using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using the Cochrane Q (Q) and I2 statistics.ResultsThe search yielded 10 420 articles, from which 21 longitudinal studies were selected. Most studies (85%) were of high quality. For 10 studies evaluating organ damage (SDI) as a continuous variable and reporting HR as a measure of association, a 1-unit increase in SDI was associated with increased mortality; pooled HR was 1.34 (95% CI: 1.24 to 1.44, p<0.001; Q p=0.027, I2=52.1%). Exclusion of one potential outlying study reduced heterogeneity with minimal impact on pooled HR (1.33 (95% CI: 1.25 to 1.42), p<0.001, Q p=0.087, I2=42.0%). The 11 remaining studies, although they could not be aggregated because of their varying patient populations and analyses, consistently demonstrated that greater SDI was associated with increased mortality.ConclusionsOrgan damage in SLE is consistently associated with increased mortality across studies from various countries. Modifying the disease course with effective therapies and steroid-sparing regimens may reduce organ damage, improve outcomes and decrease mortality for patients with SLE.

What Does It Mean to Be a British Isles Lupus Assessment Group–Based Composite Lupus Assessment Responder? Post Hoc Analysis of Two Phase III Trials

“…Flares, with or without an increase in glucocorticoid dosage, pose significant risks to patients with SLE. In the long term, both disease flares and oral glucocorticoid use have been linked to organ damage, which itself increases mortality ( 22 , 23 , 24 , 25 , 26 ). Flares are also associated with reduced health‐related quality of life, and flare severity together with oral glucocorticoid use correlate with health care costs ( 27 , 28 , 29 , 30 , 31 ).…”

Anifrolumab reduces flare rates in patients with moderate to severe systemic lupus erythematosus

“…[9][10][11] It has been well documented that disease activity, steroid use, and organ damage increase mortality risk in patients with SLE. [12][13][14][15][16] Therefore, a major goal of long-term SLE management is to prevent flares while minimizing toxicity of treatments. 1,2 Anifrolumab, a human immunoglobulin G1OE antibody that binds the type I interferon (IFN) receptor, [17][18][19] has been shown to reduce disease activity in patients with SLE.…”

Trends in mortality from lupus in Spain from 1980 to 2018

“…Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease, characterized by flares which can be associated with multiple organs damage and affects over five millions people worldwide. 1,2 International prevalence has been estimated from 30 to 150 per 100,000 and global incidence rate from 2,2 to 23,1 per 100,000 per year. 3 SLE prevalence in Spain has been reported as 210 cases per 100.000 inhabitants (95% CI 110, 400).…”