Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016

• Published in: Annals of the rheumatic diseases Vol. 76; no. 12; pp. 2009 - 2016
• Main Authors: Tektonidou, Maria G, Lewandowski, Laura B, Hu, Jinxian, Dasgupta, Abhijit, Ward, Michael M
• Format: Journal Article
• Language: English
• Published: United States BMJ Publishing Group Ltd and European League Against Rheumatism 01.12.2017; Elsevier Limited
• Subjects: Adolescent; Adult; Adults; Arthritis; Bayes Theorem; Bayesian analysis; Calendars; Child; Children; Clinical and epidemiological research; Cohort Studies; Developed Countries - statistics & numerical data; Developing Countries - statistics & numerical data; Disease; Epidemiology; Estimates; Female; Health care access; High income; Human subjects; Humans; Income - statistics & numerical data; Literature reviews; Lupus; Lupus Erythematosus, Systemic - mortality; Male; Meta-analysis; Middle Aged; Mortality; Patients; pediatric; Quality; Risk Factors; Studies; Survival; Survival Rate - trends; Systematic review; Systemic lupus erythematosus; Time Factors; Trends; mortality; systemic lupus erythematosus; adult; survival; pediatric
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2017-211663

ObjectiveTo determine trends in survival among adult and paediatric patients with systemic lupus erythematosus (SLE) from 1950 to the present.MethodsWe 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.ResultsWe 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.ConclusionsAfter 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.