- Patients with systemic lupus erythematosus (SLE) had a 1.8-fold increased mortality rate compared with the general population.
- Young age and cumulative glucocorticoid exposure were associated with an increased risk of mortality.
- Hydroxychloroquine (HCQ) exposure was associated with a 45% reduced mortality in the lowest cumulative dosage group.
Why this matters
- Findings warrant future studies to determine the mechanisms behind the increased mortality in SLE and develop interventions to improve survival.
- This population-based cohort study included 4356 patients with SLE and 21,845 age- and sex-matched control participants using data from the Clinical Practice Research Datalink (CPRD; from 1987 to 2012).
- Funding: None.
- Patients with SLE vs control group had a 1.8-fold increased rate of all-cause mortality (adjusted HR [aHR], 1.80; 95% CI, 1.57-2.08).
- The risk was higher in the youngest age group (18-39 years; aHR, 4.87; 95% CI, 1.93-12.3) and decreased through age groups (≥80 years; aHR, 1.07; 95% CI, 0.79-1.46).
- The risk of mortality was slightly higher in women vs men with SLE (aHR: 1.82 [95% CI, 1.56-2.13] vs 1.68 [95% CI, 1.19-2.39]); however, this difference was not statistically significant (P=.332).
- Cumulative glucocorticoid use was associated with an increased risk of all-cause mortality:
- any current use (aHR, 2.60; 95% CI, 2.12-3.20);
- 1-181 mg (aHR, 3.37; 95% CI, 2.35-4.81);
- 181-730 mg (aHR, 2.06; 95% CI, 1.49-2.85); and
- >730 mg (aHR, 2.66; 95% CI, 2.11-3.35).
- HCQ use was associated with reduced mortality risk, but this association was significant only in the lowest cumulative exposure group (1-181 mg: aHR, 0.55; 95% CI, 0.31-0.98).
- After adjustment, mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide were significantly increased in patients with SLE vs control group, whereas the mortality rate for cancer was reduced.
- Study did not have data on disease activity and organ damage.