OBJECTIVES: Systemic lupus erythematosus (SLE) is the most common type of lupus. Patients with cutaneous lupus erythematosus (CLE) are considered at risk for developing SLE. The objective of this study was to investigate the transition rate from CLE to SLE and the associated risk factors.

METHODS: A systematic search was performed across Embase^® and MEDLINE^® databases (from 2001 to May 2023) to identify relevant studies reporting CLE to SLE progression data and risk factors. Two independent reviewers reviewed each study, and a third reviewer resolved disagreements. The analysis was performed using Stata-17 software.

RESULTS: Among the 637 publications identified and screened, 21 studies reported the progression rate of adult CLE patients to SLE. The sample size ranged from 35 to 20878 (studies with <30 patients were excluded). The rate of CLE to SLE progression ranged from 4.3% to 57.1% among the included 21 studies. However, these studies varied in terms of sample size, geography, design, follow-up duration, and diagnostic criteria. A meta-analysis of included studies revealed an estimated 15% rate of CLE to SLE progression. The risk factors for progression were reported in 16 studies. The most common factors associated with SLE development were positive antinuclear antibody (ANA), female gender, earlier age onset, hematologic abnormalities, joint involvement, LE-specific skin lesions, presence of immunologic disorders, mucocutaneous criteria, the total number of ACR criteria, SLICC immunologic criteria and total criteria and generalized DLE.

CONCLUSIONS: This study provides a broader range and meta-analyzed estimates for progression of CLE to SLE. A considerable proportion of CLE patients move to SLE, and this study advocates the need for continuous monitoring of CLE patients. This study also highlights the need for further research to understand the impact of transition from CLE on SLE trial outcomes. Large-multicentre studies are needed better to understand CLE to SLE transition rate and risk factors.