Long-Term Outcome in Systemic Lupus Erythematosus; Knowledge from Population-Based Cohorts

Abstract

Background: Accurate knowledge of outcomes in Systemic Lupus Erythematosus (SLE) is crucial to understanding the true burden of the disease. The main objective of this systematic review was to gather all population-based studies on mortality, end-stage renal disease (ESRD) and cancer in SLE. Method: We performed a systematic literature search in two electronic databases (MEDLINE and Embase) to identify all population-based articles on SLE and survival, mortality, ESRD and cancer. The SLE diagnosis had to be verified. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Results: We included 40/1041 articles on mortality (27), ESRD (11) and cancer (3), of which six were defined as inception studies. In the total SLE cohort, the standardized mortality ratio ranged from 1.9 to 4.6. Cardiovascular disease was the most frequent cause of death in studies with follow-up times over 15 years. SLE progressed to ESRD in 5–11% of all SLE patients. There are no data supporting increased cancer incidence from population-based inception cohorts. Conclusion: There is a need for more population-based studies on outcomes of SLE, especially inception studies, with the use of control groups and follow-up times over 15 years.

Clustering of systemic lupus erythematosus mortality in southwestern Spain

“…4 The incidence, prevalence, survival and mortality of SLE have been found to vary not only between countries but also within them. [5][6][7] Similar disparities were also observed in population groups of the same ethnicity living in different parts of the world, suggesting not only a genetic predisposition but also the influence of geographical and environmental factors. 8 Despite the heterogeneous nature of SLE, the broad spectrum of presentation and the severity of disease, these outcomes may be related to differences in ethnicity, economic status, educational level, well-being status, level of social support, geographical location and treatment adherence.…”

Clinical Heterogeneity, Unmet Needs and Long-Term Outcomes in Patients with Systemic Lupus Erythematosus

“…In a systematic literature review, Reppe Moe et al compiled data on mortality, endstage kidney disease (ESKD), and cancer from population-based studies, and found that cardiovascular disease was the most frequent cause of death over 15 years of followup. Moreover, 5-11% of patients developed ESKD, and no evidence for increased cancer incidence was found [22].…”

Declining Incidence of Systemic Lupus Erythematosus in Norway 1999–2017: Data From a Population Cohort Identified by International Classification of Diseases, 10th Revision Code and Verified by Classification

“…1 In the absence of diagnostic criteria, the "gold standard" case definition for SLE is "diagnosis confirmed by expert clinical assessment." 3,4 Individual case ascertainment (by experts) is therefore the gold standard case definition for all types of SLE research, including studies of SLE epidemiology at population level. Accordingly, to establish population-based SLE cohorts, three sequential steps appear necessary.…”