Mortality rates remain elevated in patients with SLE, scleroderma
By Claire Barnard, Senior medwireNews Reporter
People with systemic lupus erythematosus (SLE) or scleroderma had a significantly higher risk for all-cause mortality than the general population in 2015–2019, with the greatest excess risk seen in men and younger patients, suggest findings from a large study published in RMD Open.
On the other hand, Petros Sfikakis (University of Athens, Greece) and colleagues found that mortality rates in people with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were not elevated relative to those seen in the general population.
“Availability of effective therapeutic options, treat-to-target strategies and perhaps better control of cardiovascular comorbidities over the last years” in patients with inflammatory arthritis may explain these findings, say the researchers who suggest that “similar approaches should be implemented in all systemic rheumatic diseases.”
Sfikakis and team used a Greek population database to evaluate data from 42,735 people with RA, 13,779 with PsA, 10,440 with SLE, 9707 with AS and 2277 with scleroderma who were receiving prescribed treatment between 2015 and 2019. These patients were age- and sex-matched to people from the general population using a 1:5 ratio.
During the 5-year study period, the overall mortality rate was 15.00 per 1000 person–years for people with SLE, compared with 9.20 per 1000 person–years for their matched general population controls, translating into a significant 1.65-fold increased mortality risk in the SLE group. People with scleroderma had a significant 2.72-fold higher mortality risk than their matched controls, at rates of 33.70 and 12.45 per 1000 person–years, respectively.
Conversely, overall mortality rates per 1000 person–years during the 5-year period were lower in patients with RA (19.07 vs 24.16), PsA (8.22 vs 10.33), or AS (4.57 vs 6.12) than their matched controls from the general population.
In all disease groups, the risk for mortality compared with controls was higher in the final 2 years of the study than in the first 3 years, which the researchers say is “possibly due to increases in disease duration”.
Sfikakis et al also found that men with SLE or scleroderma “fare considerably worse compared with their female counterparts.” For instance, during the final 2 years of follow-up, SLE was associated with a significant 1.91-fold increased mortality risk among men, compared with a significant 1.87-fold increased risk among women, while scleroderma was associated with a significant 7.28- and 3.90-fold increased risks, respectively.
A second subgroup analysis showed that the association between SLE and all-cause mortality during the study period “was more pronounced among younger patients”, say the study authors, noting that this “was also true for younger patients with [scleroderma] during the first 3 years of follow-up.”
These findings indicate that “[m]ale gender and younger age in SLE and [scleroderma] are adverse prognostic factors, highlighting that these patients need closer follow-up and more effective treatments”, conclude Sfikakis and team.
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RMD Open 2021; 7: e001694