The characteristics of published articles concerning risk factors of flare selected for the systemic review and meta-analysis
| Study, country (design) | Flare/ Non-flare numbers | Risk factors, effect size (95% CI) | ||||
| Age | Female | SACQ | Treatment | Other risk factors | ||
| Fasano et al,21 Italy (cohort) | 9/47 | HR 0.97 (0.93 to 1.02); WMD: −2.59 (−4.15 to 0.06) | / | HR 2.99 (1.08 to 8.25)* hypocomplementaemia: HR 25.97 (3.12 to 216.18) anti-dsDNA: HR 1.03 (1.01 to 1.07) | HCQ: HR 1.62 (0.19 to 13.46); duration of HCQ: HR 0.84 (0.72 to 0.98); IS: HR 2.39 (0.86 to 6.62) | Disease duration: HR 1.01 (0.92 to 1.10); WMD −3.00 (−61.12 to 55.12) Remission duration: WMD −15.84 (−34.46 to 2.78) 5-year remission: HR 0.12 (0.04 to 0.39) GC duration: WMD −18.36 (−77.67 to 40.95) LN: HR 3.38 (1.22 to 9.33) SDI score: HR 1.13 (0.63 to 2.01) |
| Mathian et al20, France (RCT) | 17/46 | / | OR 6.65 (0.36 to 123) | Low C3: OR 0.70 (0.195 to 2.541) anti-dsDNA: OR 1.16 (0.38 to 3.53) | HCQ: OR 0.44 (0.09 to 2.23); IS: OR 0.87 (0.24 to 3.20) | / |
| Tselios et al,23 Canada (cohort) abstract | 12/102 | / | / | / | IS at baseline: HR 0.64 (0.44 to 0.94) | / |
| Tani et al,19 Italy (cohort) | 18/59 | / | / | Clinical remission (not complete remission): OR 0.53 (0.16 to 1.79) | HCQ: OR 0.89 (0.27 to 2.90); IS: OR 0.56 (0.18 to 1.78); biologics: OR 0.33 (0.02 to 6.49) | Disease duration: OR 1.01 (0.94 to 1.07) Remission duration: aOR 0.8 (0.64 to 1.8) Complete remission: OR 0.73 (0.25 to 2.18) LLDAS: OR 4.47 (0.89 to 22.4) SLEDAI: aOR 1.11 (0.72 to 1.00) SDI score 0.45 (0.10 to 1.86) |
| Goswami et al,18 India (cohort) | 31/117 | aHR 1.00 (0.98 to 1.02); WMD −3.60 (−6.78 to 0.42) | HR 0.85 (0.54 to 1.33) | HR 1.18 (0.72 to 1.94) | IS: aHR 0.53 (0.35 to 0.80) | Disease duration: aHR 1.12 (1.06 to 1.19) GC duration: aHR 1.00 (1.00 to 1.00) Myositis: aHR 1.23 (0.24 to 1.25) NP-SLE: aHR 0.96 (0.47 to 1.96) Thrombocytopenia: aHR 0.79 (0.31 to 2.04) vasculitis: HR 1.00 (0.31 to 3.12) Arthritis: HR 0.65 (0.31 to 1.33) Mucocutaneous: HR 0.92 (0.62 to 1.37) Serositis: HR 0.85 (0.45 to 1.64) LN: HR 0.94 (0.65 to 1.37) SDI >0: HR 1.30 (0.78 to 2.15) |
| Nalotto et al,22 Italy (cohort) abstract | 22/82 | WMD −1.14 (−6.23 to 3.95) | OR 8.74 (0.50 to 153) | aOR 3.17 (0.37 to 27.0) | IS: OR 1.08 (0.42 to 2.82) | Disease duration: WMD 4.39 (−49.48 to 58.26) GC duration: WMD 12.39 (−32.11 to 56.89) Remission duration: WMD −6.33 (−18.56 to 5.90) Mucocutaneous: aOR 3.07 (1.11 to 8.53) Arthritis: aOR 2.75 (0.80 to 9.44) Heamatological involvement: aOR 1.89 (0.62 to 5.73) Vasculitis: OR 1.95 (0.33 to 11.4) Serositis: OR 0.84 (0.22 to 3.25) LN: OR 0.66 (0.25 to 1.70) NP-SLE: OR 0.92 (0.18 to 4.70) SDI >3: OR 0.92 (0.18 to 4.70) |
| Moroni et al,17 Italy (cohort) | 20/32 | WMD −0.30 (−4.54 to 3.94) | OR 0.60 (0.08 to 4.64) | anti-dsDNA: OR 0.56 (0.16 to 1.92) low C3: OR 1.92 (0.55 to 6.67) low C4: OR 0.94 (0.28 to 3.17) | Chloroquine: 0.10 (0.02 to 0.49) | GC duration: WMD −67.10 (−95.32 to –38.88) Remission duration: WMD −40.80 (−57.93 to –23.67) |
| Arnal et al,16 France (cohort) | 3/7 | / | / | / | / | GC duration: WMD 34.30 (1.72 to 66.88) |
| Euler et al15, Germany (cohort)† | 3/8 | WMD 3.00 (−8.74 to 14.74) | / | / | / | Disease duration: WMD −56.13 (−79.08 to –33.17) |
If available, we extracted the risk estimates that were adjusted for the most variables. When no raw data were available, HRs were taken as good estimates of ORs.
*The HR value of SACQ in Fasano, 2021 seems to have some mistakes, so we used the HR value.24
†These patients received three consecutive plasmaphereses, followed by very high-dose cyclophosphamide pulse therapy in the initial stage. One patient was excluded because she died from sequelae of the liver cirrhosis during the follow-up.
./, not available; aHR, adjusted HR; aOR, adjusted OR; dsDNA, double-stranded DNA; GC, glucocorticoids; HCQ, hydroxychloroquine; IS, immunosuppressant; LLDAS, low lupus disease activity score; LN, lupus nephritis; NP, neuropsychiatric; RCT, randomised controlled trial; SACQ, serologically active clinically quiescent; SDI, Systemic Lupus International Collaborating Clinics Damage Index; SLEDAI, SLE Disease Activity Index; WMD, weighted mean difference.