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PAINSCAN LITERATURE REVIEW
Issue 1, Volume 1
Systemic Lupus Erythematosus (SLE): Current Issues in Management
8 Articles in this Series
Introduction
Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus, a prospective cohort study
Global Trend of Survival and Damage of Systemic Lupus Erythematosus: Meta-Analysis and Meta-Regression of Observational Studies from the 1950s to 2000s
Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response
Mycophenolate versus Azathioprine as Maintenance Therapy for Lupus Nephritis
Therapy of lupus nephritis: lessons learned from clinical research and daily care of patients
Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort
How to treat refractory arthritis in lupus?
Weight loss and improvement in fatigue in systemic lupus erythematosus: a controlled trial of a low glycaemic index diet versus a calorie restricted diet in patients treated with corticosteroids

Global Trend of Survival and Damage of Systemic Lupus Erythematosus: Meta-Analysis and Meta-Regression of Observational Studies from the 1950s to 2000s

Semin Arthritis Rheum. 2012;[published online ahead of print January 16, 2012]:doi: 10.1016/j.semarthrit.2011.11.002

Introduction:  The survival rate of people with systemic lupus erythematosus (SLE) has increased from around 50% in the 1960s to more than 90% in the 1990s.  However, it seems to have reached a plateau between the 1980s and the 1990s.  One hypothesis to explain the plateau is that damage accrual limits survival; as SLE patients live longer, their organs sustain more damage.

This theory has not been supported by scientific studies, leading to the objective of this study, namely to determine whether certain categories of lupus-related organ damage adversely affect SLE long-term survival.  Meta-analysis was used in order to synthesize the results of many studies run over the past 5 decades.

Methods:  Studies published between January 1, 1950, and July 31, 2010, that were retrospective, cross-sectional, and prospective observational studies addressing survival and damage in SLE were included.  Effect size was calculated based on the logit of the overall 5- and 10-year survival rates using the random-effect model.  After adjusting for potential dependence on the data, the pooled logit and its 95% confidence interval (CI) were transformed back in to the 5- and 10-year survival rates; this was done to facilitate interpretations. Meta-regression was used to identify factors that predict the pooled survival rates.

Results:  This meta-analysis involved 77 studies with a total of 18,998 SLE patients.  From the 1950s to the 2000s, survival (both 5-year and 10-year) significantly increased.  The 5-year survival rate in the 1950s was 74.8%; in the 2000s, it was 94.8% (p<0.001).  For the 10-year survival rate, it increased from 63.2% in the 1950s to 91.4% in the 2000s (p<0.001).

There was a slowing of the survival rate between 1980 and 1990, and meta-regression showed that 2 factors negatively affected the 5-year survival rate:  neuropsychiatric and renal damage.  Neuropsychiatric damage also negatively affected the 10-year survival rate, and it should be noted that over the past 5 decades, the prevalence of neuropsychiatric damage has been significantly increasing.

Conclusions:  This meta-analysis suggests that renal and neuropsychiatric damage has adversely affected the 5- and 10-year survival rates for SLE patients over the past 5 decades.  To further improve the SLE survival rate, early detection and aggressive management of renal and neuropsychiatric involvement may be warranted.

Commentary

While 5 and 10 year survival of people with SLE has increased dramatically worldwide over the past 50 years, the rate of increase has plateaued.  This meta-analysis is interesting because authors tried to identify specific organ system involvement that impact the survival rate.  They identified damage in the renal system or the neuropsychiatric system as negatively impacting the survival rate.  These findings could relate to lack of access to hemodialysis or other treatments for severe manifestations of SLE in some parts of the world, as the survival was highly skewed by location.  Additionally, the finding of more neuropsychiatric manifestations could reflect either increased recognition or a true increase in incidence.  Nonetheless, the findings of this meta-analysis raise of the question of whether survival rates could be further increased by improving our care of the neuropsychiatric and renal manifestations of SLE.

Next Article:
Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response
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