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Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016
  1. Maria G Tektonidou1,
  2. Laura B Lewandowski2,
  3. Jinxian Hu2,
  4. Abhijit Dasgupta2,
  5. Michael M Ward2
  1. 1Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
  2. 2National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Intramural Research Program, Bethesda, Maryland, USA
  1. Correspondence to Professor Maria G Tektonidou, Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, ‘Laiko’ Hospital, 17 Agiou Thoma str., Athens 11527, Greece; mtektonidou{at}gmail.com

Abstract

Objective To determine trends in survival among adult and paediatric patients with systemic lupus erythematosus (SLE) from 1950 to the present.

Methods We performed a systematic literature review to identify all published cohort studies on survival in patients with SLE. We used Bayesian methods to derive pooled survival estimates separately for adult and paediatric patients, as well as for studies from high-income countries and low/middle-income countries. We pooled contemporaneous studies to obtain trends in survival over time. We also examined trends in major causes of death.

Results We identified 125 studies of adult patients and 51 studies of paediatric patients. Among adults, survival improved gradually from the 1950s to the mid-1990s in both high-income and low/middle-income countries, after which survival plateaued. In 2008–2016, the 5-year, 10-year and 15-year pooled survival estimates in adults from high-income countries were 0.95, 0.89 and 0.82, and in low/middle-income countries were 0.92, 0.85 and 0.79, respectively. Among children, in 2008–2016, the 5-year and 10-year pooled survival estimates from high-income countries were 0.99 and 0.97, while in low/middle-income countries were 0.85 and 0.79, respectively. The proportion of deaths due to SLE decreased over time in studies of adults and among children from high-income countries.

Conclusions After a period of major improvement, survival in SLE has plateaued since the mid-1990s. In high-income countries, 5-year survival exceeds 0.95 in both adults and children. In low/middle-income countries, 5-year and 10-year survival was lower among children than adults.

  • systemic lupus erythematosus
  • survival
  • mortality
  • pediatric
  • adult

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors MGT and MMW conceived the study. All authors designed the study, and FH, AD and MMW did the analysis. MGT drafted the manuscript, and all authors provided critical review and approval of the final version.

  • Funding This work was supported by the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (ZIAAR041153).

  • Competing interests None declared.

  • Ethics approval National Institutes of Health Office of Human Subjects Research Protection.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data on which the study is based are publicly available.

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