Abstract
BackgroundThe aim of this study was to identify the most reliable biomarkers in the literature that could be used as flare predictors in systemic lupus erythematosus (SLE).MethodsA systematic review of the literature was performed using two databases (MEDLINE and EMBASE) through April 2015 and congress abstracts from the American College of Rheumatology and the European League Against Rheumatism were reviewed from 2010 to 2014. Two independent reviewers screened titles and abstracts and analysed selected papers in detail, using a specific questionnaire. Reports addressing the relationships between one or more defined biological test(s) and the occurrence of disease exacerbation were included in the systematic review.ResultsFrom all of the databases, 4668 records were retrieved, of which 69 studies or congress abstracts were selected for the systematic review. The performance of seven types of biomarkers performed routinely in clinical practice and nine types of novel biological markers was evaluated. Despite some encouraging results for anti-double-stranded DNA antibodies, anti-C1q antibodies, B-lymphocyte stimulator and tumour necrosis factor-like weak inducer of apoptosis, none of the biomarkers stood out from the others as a potential gold standard for flare prediction. The results were heterogeneous, and a lack of standardized data prevented us from identifying a powerful biomarker.ConclusionsNo powerful conclusions could be drawn from this systematic review due to a lack of standardized data. Efforts should be undertaken to optimize future research on potential SLE biomarkers to develop validated candidates. Thus, we propose a standardized pattern for future studies.
Highlights
The aim of this study was to identify the most reliable biomarkers in the literature that could be used as flare predictors in systemic lupus erythematosus (SLE)
We conducted a systematic review of the literature to identify all of the data available on biological SLE flare predictors
Predictors of flares: biomarkers traditionally performed Anti-double-stranded DNA antibodies From a 1979 study by Swaak et al [4], changes in levels of anti-double-stranded DNA antibodies during the course of the disease were supposed to be related to SLE exacerbations
Summary
The aim of this study was to identify the most reliable biomarkers in the literature that could be used as flare predictors in systemic lupus erythematosus (SLE). Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by a relapsing–remitting course or flare pattern. Flares, defined by an increase in disease activity over a defined amount of time, can be measured using various scores. It is important to identify patients at greater risk for flares to follow them up closely, to make early diagnoses and to initiate rapid treatment or even to consider preventive therapies [2]. Since the 1970s, no investigators have succeeded in identifying a biomarker with the potential to predict efficiently the occurrence of new flares, despite great clinical necessity. We conducted a systematic review of the literature to identify all of the data available on biological SLE flare predictors
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