OBJECTIVES: The objective of this research was to conduct a systematic literature review (SLR) and meta-analyses (MAs) to evaluate the incidence rate (IR) of serious infections, fatal infections, herpes zoster (HZ), and tuberculosis (TB), as well as the association between lupus nephritis (LN) and serious infections, in patients with systemic lupus erythematosus (SLE).

METHODS: Embase, MEDLINE, and MEDLINE In-Process were searched for observational studies published between 1 January 2000 and 31 August 2020 that assessed the outcomes of interest in patients with SLE. Random-effects models were used to derive pooled estimates of the IR of each type of infection in patients with SLE, and the unadjusted odds ratio (OR) of serious infections in patients with LN compared with those with non-renal SLE. Between-study heterogeneity was assessed through Higgins I².

RESULTS: The SLR identified 18 studies that were included in MAs of the IR of 1 or more of the following infections in patients with SLE: serious infections (n = 6), fatal infections (n = 6), HZ (n = 6), or TB (n = 3). Pooled IRs (95% confidence intervals [CIs]) for these infections were 4.99 (2.78-7.82), 0.51 (0.03-1.41), 1.94 (0.96-3.24), and 0.31 (0.08-0.65) per 100 person-years (PYs), respectively. High between-study heterogeneity (I² > 70%) was observed across all pooled IRs. A second analysis of 5 studies suggested that patients with LN had statistically significantly higher odds of developing serious infections compared with patients with non-renal SLE (pooled OR [95% CI]: 2.48 [2.33-2.64]) with minimal between-study heterogeneity (I² = 23.8%).

CONCLUSIONS: Findings suggest that patients with LN have increased susceptibility to serious infections relative to patients with non-renal SLE. No definitive conclusions can be drawn on the pooled estimates of IR of serious infections, fatal infections, HZ, and TB because heterogeneity was observed across all the assessed outcomes.