Ugarte-Gil Manuel Francisco, Mendoza-Pinto Claudia, Reátegui-Sokolova Cristina, Pons-Estel Guillermo J, van Vollenhoven Ronald F, Bertsias George, Alarcon Graciela S, Pons-Estel Bernardo A
Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
Lupus Sci Med. 2021 Sep;8(1). doi: 10.1136/lupus-2021-000542.
Remission and low disease activity (LDA) have been proposed as the treatment goals for patients with systemic lupus erythematosus (SLE). Several definitions for each have been proposed in the literature.
To assess the impact of remission/LDA according to various definitions on relevant outcomes in patients with SLE.
This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using PubMed (1946-week 2, April 2021), Cochrane library (1985-week 2, week 2, April 2021) and EMBASE (1974-week 2, April 2021). We included longitudinal and cross-sectional studies in patients with SLE reporting the impact of remission and LDA (regardless their definition) on mortality, damage accrual, flares, health-related quality of life and other outcomes (cardiovascular risk, hospitalisation and direct costs). The quality of evidence was evaluated using the Newcastle-Ottawa Scale.
We identified 7497 articles; of them, 31 studies met the inclusion criteria and were evaluated. Some articles reported a positive association with survival, although this was not confirmed in all of them. Organ damage accrual was the most frequently reported outcome, and remission and LDA were reported as protective of this outcome (risk measures varying from 0.04 to 0.95 depending on the definition). Similarly, both states were associated with a lower probability of SLE flares, hospitalisations and a better health-related quality of life, in particular the physical domain.
Remission and LDA are associated with improvement in multiple outcomes in patients with SLE, thus reinforcing their relevance in clinical practice.
CRD42020162724.
缓解和低疾病活动度（LDA）已被提议作为系统性红斑狼疮（SLE）患者的治疗目标。文献中针对每一项都提出了几种定义。
根据各种定义评估缓解/LDA对SLE患者相关结局的影响。
本系统文献综述依据系统评价和Meta分析的首选报告项目，使用PubMed（1946年 - 2021年4月第2周）、Cochrane图书馆（1985年 - 2021年4月第2周）和EMBASE（1974年 - 2021年4月第2周）进行。我们纳入了SLE患者的纵向和横断面研究，这些研究报告了缓解和LDA（无论其定义如何）对死亡率、损伤累积、疾病发作、健康相关生活质量和其他结局（心血管风险、住院和直接费用）的影响。使用纽卡斯尔 - 渥太华量表评估证据质量。
我们识别出7497篇文章；其中，31项研究符合纳入标准并进行了评估。一些文章报告了与生存率的正相关关系，尽管并非所有文章都证实了这一点。器官损伤累积是最常报告的结局，并且报告称缓解和LDA对这一结局具有保护作用（风险测量值根据定义在0.04至0.95之间变化）。同样，这两种状态都与SLE疾病发作、住院的可能性较低以及更好的健康相关生活质量相关，尤其是身体领域。
缓解和LDA与SLE患者多种结局的改善相关，从而加强了它们在临床实践中的相关性。
PROSPERO注册号：CRD42020162724。
