Patients with lupus nephritis (LN) have impaired health-related quality of life (HRQoL), investigators reported in Lupus.
Kerry Gairy, MSc, of GlaxoSmithKline, Brentford, UK, and colleagues conducted a systematic review of 26 studies involving 3440 patients with LN. Of the studies, 22 assessed HRQoL (including 2 looking at patients on dialysis), 9 fatigue, and 2 health utilities.
In a quantitative analysis of 9 studies providing baseline Short Form-36 (SF-36) scores, LN significantly decreased scores across virtually all domains compared with the healthy general population. Domains included bodily pain, general health perceptions, mental health, physical functioning, emotional roles, physical roles, social functioning, and vitality. Out of a possible score of 100 or “best health” in each domain, weighted mean scores ranged from 34 to 52. Patients with LN had the lowest scores in the general health perceptions domain (37.91), physical role domain (33.77), and physical component summary (39.43).
The investigators highlighted that patients with systemic lupus erythematosus (SLE) had similarly low mental and physical component summary scores, whether or not they also had LN.
HRQoL was worse in patients with than without proliferative (III/IV) and membranous (V) LN classes, other renal factors (such as lower eGFR, higher proteinuria, and dialysis), and active SLE/LN disease, the investigators reported. Fatigue was the most burdensome symptom and increased treatment dissatisfaction.
“Fatigue is unlikely to be related only to renal activity, which emphasizes the need to manage patients with LN holistically (i.e., by treating both renal and extra-renal manifestations),” the authors wrote.
Treatment tolerability influenced HRQoL. Induction treatment with mycophenolate mofetil (MMF) versus cyclophosphamide improved HRQoL and fatigue. However, treatment comparisons were limited to cyclophosphamide, MMF, and azathioprine.
“As reflected in SLE guidelines, improved HRQoL should be a key treatment goal,” Gairy and colleagues concluded.
Disclosure: This research was supported by GlaxoSmithKline. Please see the original reference for a full list of disclosures.
Kharawala S, Kaur G, Shukla H, et al. Health-related quality of life, fatigue and health utilities in lupus nephritis: a systematic literature review. Lupus. Published online May 23, 2022. doi:10.1177/09612033221100910