New Causal Links Observed Between Drug Use and Subsequent Lupus Diagnosis

The authors of a nationwide case-control study have identified associations between multiple drugs and a subsequent diagnosis of cutaneous lupus erythematosus (CLE) or systemic lupus erythematosus (SLE).

“It has been estimated that up to 30% of all subacute CLE cases and up to 15% of SLE cases are drug-induced,” the researchers wrote. “Based on numerous case reports and several epidemiologic studies, more than 100 drugs from more than 10 drug classes are suspected to cause drug-induced lupus erythematosus.”

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To determine which drugs they would assess in this study, the researchers performed a screening process of all drugs in the Anatomical Therapeutic Chemical classification system, including drugs filled at pharmacies and drugs administered in hospitals. The study included 1298 patients with CLE and 1850 patients with SLE matched 1:10 for age and gender with 31,480 people from the general population. Patients in the study represented all incident cases of CLE and SLE in the Danish National Patient Register between 2000 and 2017.

While the researchers observed many significant associations between drug use and a subsequent diagnosis of CLE and SLE, they wrote that many were likely due to publication or protopathic bias. Nevertheless, the researchers did identify relatively well-established causal associations as well as some new plausible causal associations involving fexofenadine hydrochloride, levothyroxine sodium, metoclopramide hydrochloride, and metronidazole hydrochloride. 

Odds ratios were 2.61 for subsequent SLE and 5.05 for subsequent CLE with fexofenadine hydrochloride use; 2.46 for SLE and 1.30 for CLE with levothyroxine sodium use; 3.38 for SLE and 1.47 for CLE with metoclopramide hydrochloride use, and 1.57 for SLE and 1.93 for CLE with metronidazole hydrochloride use, according to the study.

“The study’s findings suggest that physicians should be cognizant about whether a new case of CLE or SLE could be drug-induced,” the researchers wrote.

—Jolynn Tumolo

Reference:

Haugaard JH, Kofoed K, Gislason G, Dreyer L, Egeberg A. Association between drug use and subsequent diagnosis of lupus erythematosus. JAMA Dermatol. Published online September 2, 2020. doi:10.1001/jamadermatol.2020.2786