Dataset Information

The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis.

ABSTRACT:

Objectives

We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk.

Methods

We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster infection/reactivation, opportunistic infections, pneumonia and tuberculosis. Random-effects models were used to calculate pooled risk ratios (RRs) for each type of infection. Sensitivity analysis assessed the impact of removing studies with high risk of bias.

Results

Eleven retrospective or prospective cohort studies were included in the meta-analysis: overall severe infection (n?=?4), pneumonia (n?=?6), tuberculosis (n?=?3) and herpes zoster (n?=?2). Pooled RRs for overall severe infection significantly increased for patients with SLE compared with the general population/healthy controls [RR 2.96 (95% CI 1.28, 6.83)]. Pooled RRs for pneumonia, herpes zoster and tuberculosis showed significantly increased risk compared with the general population/healthy controls [RR 2.58 (1.80, 3.70), 2.50 (2.36, 2.65) and 6.11 (3.61, 10.33), respectively]. Heterogeneity and evidence of publication bias were present for all analyses, except herpes zoster. Sensitivity analyses confirmed robustness of the results.

Conclusion

Patients with SLE have significantly higher risk of infection compared with the general population/healthy controls. Efforts to strengthen strategies aimed at preventing infections in SLE are needed.

Protocol registration

PROSPERO number: CRD42018109425.

SUBMITTER: Pego-Reigosa JM

PROVIDER: S-EPMC7785308 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis.

Pego-Reigosa José María JM Nicholson Lindsay L Pooley Nick N Langham Sue S Embleton Nina N Marjenberg Zoe Z Barut Volkan V Desta Barnabas B Wang Xia X Langham Julia J Hammond Edward R ER

Rheumatology (Oxford, England) 20210101 1

<h4>Objectives</h4>We conducted a systematic review and meta-analysis to determine the magnitude of infection risk in patients with SLE and evaluate the effect of general and SLE-related factors on infection risk.<h4>Methods</h4>We searched MEDLINE and Embase from inception to July 2018, screening for observational studies that evaluated infection risk in patients with SLE compared with the general population/healthy controls. Outcomes of interest included overall severe infection, herpes zoster ...[more]

PMID: 33099651

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Project description:BackgroundBelimumab is the first antibody drug approved for systemic lupus erythematosus (SLE), and is a fully human monoclonal antibody that inhibits soluble B lymphocyte stimulator protein. In clinical trials, a composite index was used to assess efficacy of belimumab. However, clinical guidelines on SLE treatment currently use single efficacy indexes.ObjectiveThe main objective of this study was to perform a meta-analysis to evaluate the efficacy of belimumab utilizing single indexes used in routine clinical practice, rather than the composite efficacy index used in clinical trials during the development phase. As a secondary endpoint, safety was also evaluated.MethodsSeveral databases were searched to identify reports published up to December 1, 2021 on randomized controlled trials examining the efficacy of belimumab in adult patients with SLE. From the clinical trial data, efficacy was evaluated using single indexes including the SLE Disease Activity Index (SLEDAI), British Isles Lupus Assessment Group Index, and Physician Global Assessment. Safety was also assessed. Data were synthesized and analyzed using Review Manager 5.4. This study protocol was registered in the UMIN Clinical Trials Registry (Registration number: UMIN000052846).ResultsThe search identified 12 reports that met the inclusion criteria. Five reports were included in efficacy evaluation and 9 in safety evaluation. The primary endpoint was SLEDAI. Significantly more belimumab-treated patients achieved a ≥4-point reduction in SLEDAI (relative risk 1.28; 95% confidence interval, 1.16-1.40; P < 0.00001) compared with placebo. Other efficacy endpoints were also improved significantly in the belimumab group. No difference in safety was found between belimumab and placebo.ConclusionsThe present meta-analysis evaluating clinical trial data using various single indexes recommended by clinical guidelines for SLE verifies that addition of belimumab to standard of care is efficacious for moderate-to-severe SLE.

Dataset Information

The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis.

Objectives

Methods

Results

Conclusion

Protocol registration

Publications

The risk of infections in adult patients with systemic lupus erythematosus: systematic review and meta-analysis.

Similar Datasets

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