FRI0356 Organ damage in systemic lupus erythematosus is consistently associated with increased mortality: a meta-analysis
Authors: E.R. Hammond, I.B. Murimi, D.H. Lin, H. Nab, H. Kan, O. Onasanya, J.C. Tierce, X. Wang, B. Desta, G.C. Alexander
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> More than half of all patients with systemic lupus erythematosus (SLE) develop organ damage over time, including damage to the kidney, skin, cardiovascular, musculoskeletal and central nervous systems. Several mechanisms have been associated with organ damage, including long-term steroid use. SLE organ damage, like comorbid disease, may contribute to increased mortality. <h3>Objectives</h3> We conducted a systematic literature review and meta-analysis of the association between organ damage in SLE and mortality. <h3>Methods</h3> A literature search (January 2000–February 2017) of PubMed, EMBASE, Cochrane Library, and Latin American and Caribbean Health Sciences Literature from four continents evaluating organ damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and mortality was conducted. Exclusion criteria included non–English language articles and study designs that did not report original, population-level measures of association. We used a random-effects meta-analysis to evaluate studies that modelled SDI as a continuous predictor of mortality and reported hazard ratios (HR) associated with a 1-unit SDI increase. <h3>Results</h3> The search yielded 10 420 articles, of which, 21 prospective cohort studies were selected. Ten studies evaluating SDI as a continuous variable and reporting HR as measure of association were pooled and meta-analysed. The pooled HR of mortality for a 1-unit increase in SDI was 1.34 (95% confidence interval [CI]: 1.21–1.44; p&lt;0.001). A study of 213 patients followed for 13 years in China yielded the greatest risk of mortality for a 1-unit SDI increase (HR 3.65, [95% CI: 1.52–8.76]). When excluded from the meta-analysis, the pooled HR of mortality for a 1-unit increase in SDI was 1.32 (95% CI: 1.25–1.42; p&lt;0.001). Four studies that evaluated SDI as binary variable reported HR for various SDI reference groups: SDI=0: HR 5.10 (95% CI: 1.99–13.03); SDI&lt;1: HR 3.8 (95% CI: 1.30–16.40); SDI&lt;3: HR 4.74 (95% CI: 1.55–14.51); and SDI&lt;5: HR 55.12 (95% CI: 19.15–158.63). Two studies reported odds ratios (OR) as the measure of association; for a 1-unit SDI increase, the OR was 19.7 (95% CI: 5.30–72.50), and for SDI=0 as reference group, the OR was 12 (95% CI: 1.60–92.00). <h3>Conclusions</h3> Organ damage in SLE is consistently associated with increased mortality across studies from various countries, regardless of how it is modelled. Novel therapies that are potentially disease modifying and steroid sparing could reduce organ damage, improve overall outcomes, and decrease mortality in patients with SLE. <h3>Disclosure of Interest</h3> E. Hammond Employee of: AstraZeneca, I. Murimi: None declared, D. Lin: None declared, H. Nab Employee of: AstraZeneca, H. Kan Shareholder of: GlaxoSmithKline, O. Onasanya: None declared, J. Tierce: None declared, X. Wang Employee of: AstraZeneca, B. Desta Employee of: AstraZeneca, G. C. Alexander Consultant for: Chair of the FDA's Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IQVIA, serves on the Advisory Board of MesaRx Innovations, and serves as a paid member of OptumRx's National P and T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.