Interleukin-23 levels and their association with systemic lupus erythematosus: A systematic review and meta-analysis

BackgroundSystemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease involving Interleukin-23 (IL-23), a pro-inflammatory cytokine that promotes Th17 cell differentiation, contributing to SLE pathogenesis. However, studies assessing IL-23 levels in SLE patients have reported inconsistent findings. This meta-analysis aimed to evaluate the association of circulating IL-23 levels with SLE, including their correlation with disease activity.Materials and MethodsFive databases (PubMed, Scopus, ScienceDirect, Web of Science, and EBSCOhost) were utilized for a systematic search of observational studies comparing IL-23 levels in SLE patients and healthy controls, along with the SLE Disease Activity Index (SLEDAI), to assess disease activity. The Newcastle-Ottawa Scale (NOS) was used for the data extraction process and quality assessment. Comprehensive Meta-Analysis (CMA) v4 was used as another tool to perform the meta-analysis. Moreover, robustness of findings was assured by Trial Sequential Analysis (TSA), sensitivity analysis, heterogeneity, and publication bias.ResultsResults were derived from 12 studies involving 680 SLE patients and 416 healthy controls. Elevated levels of IL-23 were reported in SLE patients compared to controls (MD = 71.467; 95% CI: 26.44-116.49; <i>p</i> = 0.002) in the pooled analysis. IL-23 levels were higher in active versus inactive SLE (MD = 27.777; <i>p</i> = 0.085), although the difference was statistically insignificant. A significant positive correlation was recorded between IL-23 and SLEDAI scores (correlation coefficient = 0.510; <i>p</i> = 0.027). Ethnicity-specific analysis supported similar trends in East Asian and Middle Eastern populations. Sensitivity and TSA confirmed the robustness and adequacy of the sample size for the association between IL-23 and SLE.ConclusionThis meta-analysis reveals a significant association between elevated IL-23 levels and SLE, suggesting its potential as a diagnostic and prognostic biomarker. Further longitudinal studies are required to validate its utility in SLE monitoring and therapy.