A systematic review of pharmacological therapies and their effectiveness on health-related quality of life outcomes in patients with juvenile-onset systemic lupus erythematosus

Abstract

Juvenile-onset systemic lupus erythematosus (JSLE) presents with an aggressive course and high morbidity associated with disease and treatment. JSLE patients have a poorer health-related quality of life (HRQoL) when compared with age-matched patients with other rheumatologic disorders. We aim to summarize the impact of current pharmacological therapies on the HRQoL of JSLE patients. Search strategies were developed across seven databases. Randomized clinical trials (RCTs) and cohort studies comparing interventions to standard therapy, placebo or pre-post cohort comparisons for more than 4 weeks were included. The outcome included self-reported scales compared at baseline and a therapeutic time point. Risk of bias was evaluated by using the Cochrane risk of bias tool and the Newcastle–Ottawa quality assessment scale. A total of 2812 articles were narrowed down to 309 for full-text screening. Four RCTs and one prospective cohort study, with a total of 634 JSLE patients, met the inclusion criteria. Four of the studies had a controlled intervention plus standard therapy compared with standard therapy alone or placebo. Multiple indices were used to evaluate HRQoL. These included the Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters tool, Kids Fatigue Severity Scale and Child Depression Inventory. A single study reported a significant improvement while remaining studies reported no difference or failed to report the statistical analysis. Although HRQoL is significantly impaired in JSLE, evidence regarding its improvement is limited due to the small number of eligible studies, heterogeneity in scales, and HRQoL domains. A universal HRQoL questionnaire for JSLE needs to be established and used in both the research and clinical setting. All studies should adhere to reporting guidelines.

Keywords

Childhood onset lupus juvenile lupus pharmacological therapies quality of life self-reported outcomes systemic lupus erythematosus

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References

Kamphuis

Silverman

. Prevalence and burden of pediatric-onset systemic lupus erythematosus. Nat Rev Rheumatol 2010; 6: 538–546.

Kone-Paut

Piram

Guillaume

Tran

. Lupus in adolescence. Lupus 2007; 16: 606–612.

Tucker

Uribe

Fernandez

, et al. Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study within LUMINA, a multiethnic US cohort (LUMINA LVII). Lupus 2008; 17: 314–322.

Brunner

Gladman

Ibanez

Urowitz

Silverman

. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 2008; 58: 556–562.

Brunner

Martini

Lovell

Ruperto

. Clinical trials in children and adolescents with systemic lupus erythematosus: methodological aspects, regulatory landscape and future opportunities. Ann Rheum Dis 2019; 78: 162–170.

Morgan

Watson

McCann

Beresford

. Children and adolescents with SLE: not just little adults. Lupus 2013; 22: 1309–1319.

Brunner

Sherrard

Klein-Gitelman

. Cost of treatment of childhood-onset systemic lupus erythematosus. Arthritis Rheum 2006; 55: 184–188.

Ruperto

Buratti

Duarte-Salazar

, et al. Health-related quality of life in juvenile-onset systemic lupus erythematosus and its relationship to disease activity and damage. Arthritis Rheum 2004; 51: 458–464.

Levy

Peschken

Tucker

, et al. Association of health-related quality of life in childhood-onset systemic lupus erythematosus with ethnicity: results from a multiethnic multicenter Canadian cohort. Arthritis Care Res (Hoboken) 2014; 66: 1767–1774.

10.

Tunnicliffe

Singh-Grewal

Craig

, et al. Healthcare and research priorities of adolescents and young adults with systemic lupus erythematosus: a mixed-methods study. J Rheumatol 2017; 44: 444–451.

11.

Tan

Cohen

Fries

, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271–1277.

12.

Moorthy

Baldino

Kurra

, et al. Relationship between health-related quality of life, disease activity and disease damage in a prospective international multicenter cohort of childhood onset systemic lupus erythematosus patients. Lupus 2017; 26: 255–265.

13.

Hayashi

Solis

Sapienza

, et al. Efficacy and safety of creatine supplementation in childhood-onset systemic lupus erythematosus: a randomized, double-blind, placebo-controlled, crossover trial. Lupus 2014; 23: 1500–1511.

14.

Lima

Paupitz

Aikawa

Takayama

Bonfa

Pereira

. Vitamin D supplementation in adolescents and young adults with juvenile systemic lupus erythematosus for improvement in disease activity and fatigue scores: a randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken) 2016; 68: 91–98.

15.

Brunner

Silva

Reiff

, et al. Randomized, double-blind, dose-escalation trial of triptorelin for ovary protection in childhood-onset systemic lupus erythematosus. Arthritis Rheumatol 2015; 67: 1377–1385.

16.

GGO Companies. A multi-center, randomized parallel group, placebo-controlled double-blind trial to evaluate the safety, efficacy, and pharmacokinetics of belimumab, a human monoclonal anti-BLyS antibody, plus standard therapy in pediatric patients with systemic lupus erythematosus. (Ongoing clinical trial). In press 2016.

17.

Ruperto

Ravelli

Cuttica

, et al. The Pediatric Rheumatology International Trials Organization criteria for the evaluation of response to therapy in juvenile systemic lupus erythematosus: prospective validation of the disease activity core set. Arthritis Rheum 2005; 52: 2854–2864.

18.

Ruperto

Ravelli

Oliveira

, et al. The Pediatric Rheumatology International Trials Organization/American College of Rheumatology provisional criteria for the evaluation of response to therapy in juvenile systemic lupus erythematosus: prospective validation of the definition of improvement. Arthritis Rheum 2006; 55: 355–363.

19.

Elera-Fitzcarrald

Fuentes

Gonzalez

Burgos

Alarcon

Ugarte-Gil

. Factors affecting quality of life in patients with systemic lupus erythematosus: important considerations and potential interventions. Expert Review Clinical Immunol 2018; 14: 915–931.

20.

Mikdashi

. Measuring and monitoring health-related quality of life responsiveness in systemic lupus erythematosus patients: current perspectives. Patient Relat Outcome Meas 2018; 9: 339–343.

21.

Brunner

Higgins

Wiers

, et al. Health-related quality of life and its relationship to patient disease course in childhood-onset systemic lupus erythematosus. J Rheumatol 2009; 36: 1536–1545.

22.

Houghton

Tucker

Potts

McKenzie

. Fitness, fatigue, disease activity, and quality of life in pediatric lupus. Arthritis Rheum 2008; 59: 537–545.

23.

Moorthy

Harrison

Peterson

Onel

Lehman

. Relationship of quality of life and physical function measures with disease activity in children with systemic lupus erythematosus. Lupus 2005; 14: 280–287.

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