SLE: significant excess mortality versus the general population

Presented by

Dr Mia Rodziewicz, University of Manchester, UK

Conference

EULAR 2023

Despite progress in the management of systemic lupus erythematosus (SLE), patients with SLE have been found to have higher all-cause mortality than the general population. British registry data determined a standardised mortality ratio (SMR) of 4.74.

As advancements in treatments have improved survival in patients with SLE, current rates of mortality and cancer incidence were at the centre of research led by Dr Mia Rodziewicz (University of Manchester, UK) to determine the current status. A cohort of 1,463 patients with SLE from the UK-based British Isles Lupus Assessment Group Biologics Registry (BILAG-BR) from the years 2010-2021 was analysed [1]. Also, data from the UK National Cancer Register was incorporated into the analysis. Findings for the SLE patients were compared with the general UK population by calculating the SMR, as well as the standardised incidence ratio (SIR) for cancer.

A total of 54 deaths occurred, equalling an SMR of 4.74 (95% CI 3.63–6.19), with infection being the cause of mortality in 40.7% of cases, followed by SLE in 20.3%, and cancer in 11.1%. New cancer diagnoses were reported in 33 individuals within the study period, amounting to a SIR of 1.21 (95% CI 0.85–1.72) versus the UK general population.

Subgroups were compared for their cancer risk according to their treatment by evaluating the standard of care versus rituximab or belimumab. The resulting age and gender-adjusted hazard ratios (HR) were 1.49 (95% CI 0.57–3.92) for rituximab and 2.47 (95% CI 0.57–10.58) for belimumab. The corresponding HR for death in patients on these therapies that additionally included adjusting for comorbidities were 3.08 (95% CI 0.92–10.33) and 1.31 (95% CI 0.13–13.05), respectively.

In their conclusion, the authors saw no clear difference between the cancer risk of SLE patients and the general population. In contrast, they underlined that there is still significantly greater mortality in individuals with SLE compared with British citizens without SLE.

Rodziewicz M, et al. All-cause mortality and the incidence of cancer in patients with moderate-to-severe SLE: results from the British Isles Lupus Assessment Group Biologics Registry (BILAG-BR). POS0170, EULAR 2023, 31 May–3 June, Milan, Italy.

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