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Contrary to current thought and after a long period of major improvement, survival rates have not been going up.
Survival rates for patients with systemic lupus erythematosus have plateaued since the middle of the 1990s after a period of major improvement starting in the 1950s.
It has been thought that survival in systemic lupus erythematosus has continued to improve over the years, with reports of survival in adults increasing from 50% in the 1950s to more than 95% in the 1990s.
Data with regard to survival trends in low- and middle-income countries and at 10- and 15-year periods are limited, so Maria Tektonidou and fellow researchers in Greece sought to describe mortality trends for children and adults with systemic lupus erythematosus and presented their findings in a recent Annals of the Rheumatic Diseases article.
The authors performed a systematic review of the literature, looking at children and adults with systemic lupus erythematosus. Ultimately included in the final analysis were 171 studies; 125 looked at adult survival rates, 51 at pediatric survival, and 5 at both.
• Studies in high-income countries showed a steady increase in survival from the middle of the 1950s to 1990. Survival rates have remained stable since then.
• Five-year survival in high-income countries is greater than 95% in both adults and children who have systemic lupus erythematosus.
• Five- and 10 year survival was lower for children than adults in low- to middle-income countries.
• Survival in adults with systemic lupus erythematosus has not continued to improve through the 2000s.
• From 2008 to 2016, survival rates for adults with systemic lupus erythematosus in high-income countries at 5, 10, and 15 years were 0.95, 0.89, and 0.82, respectively (95% confidence intervals [CIs], 0.94-0.96, 0.88-0.90, and 0.81-0.83, respectively).
• From 2008 to 2016, survival rates for adults with systemic lupus erythematosus in low- to middle-income countries at 5, 10, and 15 years were 0.92, 0.85, and 0.79, respectively (95% CIs, 0.91-0.93, 0.84-0.87, and 0.78-0.81, respectively).
• From 2008 to 2016, survival rates for children with systemic lupus erythematosus in high-income countries at 5 and 10 years were 0.99 and 0.97, respectively (95% CIs, 0.98-1.0 and 0.96-0.98, respectively).
• From 1980 to 2000, survival rates for children with systemic lupus erythematosus in low- to middle-income countries at 5 and 10 years were 0.85 and 0.79, respectively (95% CIs, 0.83-0.88 and 0.76-0.82, respectively).
• Listing of systemic lupus erythematosus as the cause of death in all cohorts decreased over time.
Implications for physicians
• Although survival in adults and children with systemic lupus erythematosus both in high-income and in low/middle-income countries has improved dramatically since the 1950s, further gains have not been realized in the 2000s.
• A decreased frequency of deaths attributed to systemic lupus erythematosus may be the result of new immunosuppressive drugs and combination therapies.
• No increase in death resulting from cardiovascular events or cancer was seen in adults with systemic lupus erythematosus.
• The authors suggested that strides need to be made in determining why survival rates are lower in children than in adults in low- and middle-income countries.
The authors’ work was supported by the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH.
Tektonidou M, Lewandowski L, Hu J, et al. “Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016.” Ann Rheum Dis. 2017 Aug 9. pii: annrheumdis-2017-211663. doi: 10.1136/annrheumdis-2017-211663. [Epub ahead of print]