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. 2021 Jan 5;60(1):207-216.
doi: 10.1093/rheumatology/keaa267.

Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Irene E M Bultink  1 , Frank de Vries  2   3 , Ronald F van Vollenhoven  1 , Arief Lalmohamed  2   4
Affiliations

Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Irene E M Bultink et al. Rheumatology (Oxford). .

Abstract

Objectives: We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE.

Methods: We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios.

Results: Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18-39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls.

Conclusion: British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

Keywords: cause of death; glucocorticosteroids; hydroxychloroquine; mortality; systemic lupus erythematosus; treatment.

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Figures

Fig. 1
Fig. 1
Spline regression plot of age and RR for mortality in SLE patients vs matched controls Adjusted for age and sex. RR: rate ratio.
Fig. 2
Fig. 2
Spline regression plot of age and RR for mortality in SLE patients vs matched controls Adjusted for confounders as shown in Table 2. RR: rate ratio.
See this image and copyright information in PMC

References

    1. Merrell M, Shulman LE.. Determination of prognosis in chronic disease, illustrated by systemic lupus erythematosus. J Chron Dis 1955;1:12–32. - PubMed
    1. Mok CC, Lee KW, Ho CT, Lau CS, Wong R.. A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population. Rheumatology 2000;39:399–406. - PubMed
    1. Mak A, Cheung MW, Chiew HJ, Liu Y, Ho RC.. 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;41:830–9. - PubMed
    1. Elfving P, Puolakka K, Kautiainen H. et al. Mortality and causes of death among incident cases of systemic lupus erythematosus in Finland 2000–2008. Lupus 2014;23:1430–5. - PubMed
    1. Bernatsky S, Boivin J-F, Joseph L. et al. Mortality in systemic lupus erythematosus. Arthritis Rheum 2006;54:2550–7. - PubMed

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