Background/Purpose: The association between cigarette smoking and the occurrence of SLE has been studied over the past two decades but results are conflicting. The global increase in women smokers and the availability of prospective data addressing the risk of the development of SLE and cigarette smoking warrant an update on the evidence of the relationship between cigarette smoking and the occurrence of SLE. This study aims to refine the association between cigarette smoking and the odds of SLE occurrence by Bayesian multivariate meta-analysis of case-control and cohort studies.

Methods: An extensive literature search using the relevant keywords including “systemic lupus erythematosus”; “lupus’; “smoking”; “cigarette smoking”; “environmental”; “autoimmune disease” and “connective tissue disease” in various combinations was performed in order to identify case-control and cohort studies addressing the relationship between cigarette smoking and SLE published in English in computerized databases including PubMed (from 1966 to Jan 2018), Embase (1980 to Jan 2018) and Cochrane Central Register of Control Trials (last quarter of 2017). A Bayesian multivariate meta-analysis was conducted by computing the log odds ratios (ORs) between current and never smokers, and between ex-smokers and never smokers. Following which, the sampling covariances of the effect sizes were calculated and heterogeneity variances of the case-control and cohort studies were assumed to be the same. The average log ORs, the heterogeneity (SDs) and their corresponding 95% credible intervals (CIs) of the posterior distributions were then reported.

Results: Twelve relevant studies (10 retrospective case-control and 2 cohort) were eligible for the meta-analysis. Data were aggregated based on smoking statuses comprising current, ever and never smoking. Bayesian analysis of combination of the case-control and cohort studies revealed significant relationship between the occurrence of SLE and current smoking (log OR 0.43, 95% CI [0.07, 0.81]), and a smaller and insignificant association between SLE and ever smoking (log OR 0.33, 95% CI [-0.05; 0.74]). The year of publication, patients’ mean age and the proportion of female subjects in the studies were not mediators for the aggregated effect sizes.

Conclusion: Current smoking is associated with the occurrence of SLE based on the Bayesian aggregation of effect sizes from case-control and cohort studies. The higher risk of development of SLE in current but not among ex-smokers compared to never smokers warrants further mechanistic studies to unravel the actual immunologic impact of cigarette smoke on SLE development in different subsets of SLE patients, and highlights the importance of smoking cessation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-cigarette-smoking-and-systemic-lupus-erythematosus-a-bayesian-multivariate-meta-analysis-of-case-control-and-cohort-studies/