Bullous Pemphigoid Associated With Several Medications
The development of bullous pemphigoid (BP) may be associated with the use of aldosterone antagonists, dipeptidyl peptidase 4 inhibitors, anticholinergics, and dopaminergic medications, according to the findings of a recent systematic review and meta-analysis.
In their systematic review, the researchers identified case-control or cohort studies, as well as randomized clinical trials, that had examined the odds or risk of BP associated with previous medication use. A total of 13 case-control studies, one cohort study, and one randomized clinical trial were included in the meta-analysis (N=285,884).
The researchers followed the Meta-analysis of Observational Studies in Epidemiology guideline, using the Newcastle-Ottawa Scale to evaluate the risk of bias in observational studies and Cochrane Collaboration’s tool for the randomized clinical trial. They used random-effects model meta-analysis for aggregate data in studies that were sufficiently homogenous and performed subgroup analyses for use of various medications of the same category. In addition, the researchers calculated odds ratio (OR), hazard ratio (HR), and the risk ratio of BP in association with medication use.
In their meta-analysis of case-control studies, the researchers observed a significant association between BP and previous use of aldosterone antagonists (pooled OR, 1.75; 95% CI, 1.28-2.40), dipeptidyl peptidase 4 inhibitors (pooled OR, 1.92; 95% CI, 1.55-2.38), anticholinergics (pooled OR, 3.12; 95% CI, 1.54-6.33), and dopaminergic medications (pooled OR, 2.03; 95% CI, 1.34-3.05). In addition, the cohort study showed an increased risk of BP among patients being treated with dipeptidyl peptidase 4 inhibitors (HR, 2.38; 95% CI, 1.16-4.88; P =.02). The randomized clinical trial also found a higher occurrence of BP among patients with diabetes who were treated with linagliptin compared with the placebo group (0.2% vs 0%).
“These medications should be judiciously prescribed, particularly in high-risk patients who are elderly and have disabling neurologic disorders,” the researchers concluded.
Reference
Liu S, Chen W, Chi C. Association between medication use and bullous pemphigoid: a systematic review and meta-analysis. JAMA Dermatol. Published online June 17, 2020. doi:10.1001/jamadermatol.2020.1587
Is Atopic Eczema Associated With Cancer?
Data from two large cohort studies did not show an association between atopic eczema (AE) and most cancers; however, researchers observed an increased risk for noncutaneous lymphomas based on AE severity. The results of their studies were published in JAMA Dermatology.
Previous evidence on the association between AE and cancer has been unclear, the researchers said. They noted that it was also important to determine the baseline risk for cancers among patients with AE before exploring the potential association between new biologic therapies for AE and cancer risk.
In their study, the researchers used data from a large cohort study in England, which included 471,970 individuals with AE and 2,239,775 individuals without AE from nationwide primary care data, as well as a large cohort study from nationwide Danish data, which included 44,945 individuals with AE and 445,673 individuals without AE. The researchers compared overall cancer risk and risk of specific cancers between those with and those without AE.
In both the English and Denmark cohorts, the researchers found little evidence of association between AE and overall cancer risk (adjusted hazard ratio [aHR], 1.04; 99% CI, 1.02-1.06; and aHR, 1.05; 99% CI, 0.95-1.16, respectively) or the risk for most specific cancers.
Notably, the researchers found an increased risk of noncutaneous lymphoma among individuals with AE in the English cohort (aHR for non-Hodgkin lymphoma, 1.19; 99% CI, 1.07-1.34; and aHR for Hodgkin lymphoma, 1.48; 99% CI, 1.07-2.04). Additionally, they observed an association between AE severity and lymphoma risk. Compared with individuals without AE, the aHRs for non-Hodgkin lymphoma were 1.06 (99% CI, 0.90-1.25), 1.24 (99% CI, 1.04-1.48), and 2.08 (99% CI, 1.42-3.04) for mild, moderate, and severe AE, respectively.
The Danish point estimates also showed an increased lymphoma risk among people with moderate to severe AE compared with those without AE (minimally aHR for non-Hodgkin lymphoma, 1.31; 99% CI, 0.76-2.26; and minimally aHR for Hodgkin lymphoma, 1.35; 99% CI, 0.65-2.82). However, the 99% CIs were wide, the researchers noted.
The researchers concluded that the findings from their two large population-based studies from different settings do not support associations between AE and most cancers. They added, though, that the observed increased risk for lymphoma, particularly non-Hodgkin lymphoma, in association with AE severity warrants further study due to the potential of new immunomodulatory systemic therapies to alter cancer risk.
Reference
Mansfield KE, Schmidt SAJ, Darvalics B, et al. Association between atopic eczema and cancer in England and Denmark. JAMA Dermatol. Published online June 24, 2020. doi:10.1001/jamadermatol.2020.1948
Major Depressive Disorder Increases Risk of Autoimmune Skin Diseases
A recent study found patients with major depressive disorder (MDD) had an increased risk of developing autoimmune skin diseases, including hidradenitis suppurativa and psoriasis, compared with patients without MDD.
“MDD has been implicated as a risk factor for various immune-related disorders; however, the association between MDD and subsequent autoimmune skin diseases remains unclear,” the researchers said. They investigated this association using data from the National Health Insurance Research Database in Taiwan. A total of 222,522 patients with MDD and 890,088 matched controls were included in the study.
After controlling for confounders, the researchers found that patients with MDD had an increased risk of autoimmune skin diseases compared with matched controls, (adjusted hazard ratio [aHR], 10.41; 95% CI, 9.62-11.42).
In subgroup analyses, they found patients with MDD had a significantly increased risk of developing psoriasis (aHR, 12.01; 95% CI, 10.37-13.91), lichen planus (aHR, 11.84; 95% CI, 8.90-15.75), alopecia areata (aHR, 11.61; 95% CI, 9.92-13.59), morphea (aHR, 6.03; 95% CI, 2.47-14.73), autoimmune bullous diseases (aHR, 7.67; 95% CI, 5.94-9.90), hidradenitis suppurativa (aHR, 8.45; 95% CI, 3.61-19.74), vitiligo (aHR, 7.24; 95% CI, 5.65-9.28), lupus erythematosus (aHR, 11.30; 95% CI, 9.21-13.86), systemic sclerosis (aHR, 8.07; 95% CI, 4.30-15.14), Sjögren syndrome (aHR, 6.71; 95% CI, 5.29-8.50), and dermatomyositis (aHR, 14.44; 95% CI, 5.55-37.55).
“Our data suggest that there is a need to monitor patients with MDD for the risk of developing autoimmune skin diseases,” the researchers said. “Further studies are needed to better understand the underlying mechanisms,” they concluded.
Reference
Dai YX, Tai YH, Chang YT, Chen TJ, Chen MH. Association between major depressive disorder and subsequent autoimmune skin diseases: a nationwide population-based cohort study. J Affect Disord. 2020;274:334-338. doi:10.1016/j.jad.2020.05.070
