Tedbirt, Billal; Gillibert, André; Andrieu, Emilie; Hébert, Vivien; Bastos, Sarah; Korman, Neil J; Tang, Mark B Y; Li, Jun; Borradori, Luca; Cortés, Begonia; Kim, Soo-Chan; Gual, Adrià; Xiao, Ting; Wieland, Carilyn N; Fairley, Janet A; Ezzedine, Khaled; Joly, Pascal (2021). Mixed Individual-Aggregate Data on All-Cause Mortality in Bullous Pemphigoid: A Meta-analysis. JAMA dermatology, 157(4), pp. 421-430. American Medical Association 10.1001/jamadermatol.2020.5598
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Importance
The 1-year standardized mortality ratio (SMR) of bullous pemphigoid (BP) has been reported as 2.15 to 7.56 and lower in the US than in Europe.
Objective
To estimate the worldwide 1-year SMR of BP.
Data Sources
PubMed, Embase, Cochrane Library, Google Scholar, Lissa, and gray literature (eg, medRxiv) were screened for studies of BP published from inception to June 10, 2020, with review of reference lists.
Study Selection
Retrospective and prospective studies reporting 1-year all-cause mortality rate in patients with BP and providing age statistics (eg, mean [SD]).
Data Extraction and Synthesis
Two reviewers independently extracted the data. The 1-year SMR was computed in studies reporting 1-year mortality by combining information on age obtained from studies with aggregate data and individual data. Risk of representativity, misclassification, and attrition bias were assessed by a custom tool.
Main Outcomes and Measures
The primary end point was the worldwide 1-year SMR. Secondary analysis included comparison of 1-year SMRs between continents in a meta-regression.
Results
Three studies were performed in the US (n = 260), 1 in South America (n = 45), 16 in Asia (n = 1903), and 36 in Europe (n = 10 132) for a total of 56 unique studies and 12 340 unique patients included in the meta-analysis (mean [SD] age, 77.3 [12.7] years; 55.9% women). The mean (SD) patient age in the United States was 75.6 (13.7) years; in Asia, 73.8 (13.6) years; and in Europe, 78.1 (12.3) years. The worldwide 1-year SMR was estimated at 2.93 (95% CI, 2.59-3.28; I2 = 85.6%) for all 56 studies. The 1-year SMR in the US was 2.40 (95% CI, 0.89-3.90; I2 = 86.3%) for 3 studies; in Asia, 3.53 (95% CI, 2.85-4.20; I2 = 86.3%) for 16 studies; and in Europe, 2.77 (95% CI, 2.35-3.19; I2 = 86.3%) for 36 studies. After adjustment on the expected 1-year mortality rate, the European 1-year SMR did not differ significantly from the 1-year SMR in the United States (-0.48 vs Europe; 95% CI, -2.09 to 1.14; P = .56) and Asia (0.51 vs Europe; 95% CI, -0.56 to 1.58; P = .35). Risk of attrition bias was high (>10% censorship) in 16 studies (28.6%), low in 16 (28.6%), and unclear in 24 (42.9%). Only 4 studies (7.1%) had a sampling method guaranteeing the representativity of BP cases in a population.
Conclusions and Relevance
Although heterogeneity was high and overall quality of follow-up was poor, this meta-analysis confirms the high mortality rate among patients with BP.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology |
UniBE Contributor: |
Borradori, Luca |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2168-6084 |
Publisher: |
American Medical Association |
Language: |
English |
Submitter: |
Andrea Studer-Gauch |
Date Deposited: |
06 Jul 2021 14:14 |
Last Modified: |
05 Dec 2022 15:51 |
Publisher DOI: |
10.1001/jamadermatol.2020.5598 |
PubMed ID: |
33729430 |
BORIS DOI: |
10.48350/157391 |
URI: |
https://boris.unibe.ch/id/eprint/157391 |