Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden
Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden
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DOI：
10.1111/j.1365-2133.2012.10969.x
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发表时间：
2012-08-01
影响因子：
10.3
通讯作者：
Nyberg, F.
中科院分区：
文献类型：
--
作者：
Gronhagen, C. M.;Fored, C. M.;Nyberg, F.
研究背景药物性亚急性皮肤红斑狼疮（SCLE）的病例报道很多。不同的药物类型与不同的lavenin已被提出作为触发这种自身免疫性皮肤病。目的评估暴露于某些可疑药物之间的关联方法我们进行了一项以人群为基础的配对病例对照研究，其中所有SCLE事件病例（n = 234）从2006年到2009年，来自国家患者登记册。对照组从一般人群中选择，性别、年龄和居住县匹配（1：10）。这些数据与处方药登记册相关联。结果在SCLE诊断前6个月内，166例（71%）SCLE患者至少服用过一种可疑药物。发现特比萘芬的OR增加最多（OR 52.9，95% CI 6.6-无穷大），肿瘤坏死因子-α抑制剂（OR 8.0，95% CI 1.6-37.2），抗癫痫药（OR 3.4，95% CI 1.9-5.8）和质子泵抑制剂（OR 2.9，95% CI 2.0-4.0）。超过三分之一的SCLE病例可归因于药物暴露。未发现噻嗪类药物的显著OR，这可能是由于潜伏期较长，因此在本研究设计中缺失。一旦停药，DI-SCLE是可逆的，这表明筛查SCLE患者的潜在触发药物的重要性。本研究无法确定因果关系，潜在的发病机制仍不清楚。
Background Numerous case reports about drug-induced (DI) subacute cutaneous lupus erythematosus (SCLE) have been published. Various drug types with different latencies has been proposed as triggers for this autoimmune skin disease.Objectives To evaluate the association between exposure to certain suspected drugs (previously implicated to induce SCLE) and a subsequent diagnosis of SCLE.Methods We performed a population-based matched case-control study in which all incident cases of SCLE (n = 234) from 2006 to 2009 were derived from the National Patient Register. The control group was selected from the general population, matched (1 : 10) for gender, age and county of residence. The data were linked to the Prescribed Drug Register. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between exposures to certain suspected drugs and the development of SCLE.Results During the 6 months preceding SCLE diagnosis, 166 (71%) of the patients with SCLE had at least one filled prescription of the suspected drugs. The most increased ORs were found for terbinafine (OR 52.9, 95% CI 6.6-infinity), tumour necrosis factor-alpha inhibitors (OR 8.0, 95% CI 1.6-37.2), antiepileptics (OR 3.4, 95% CI 1.9-5.8) and proton pump inhibitors (OR 2.9, 95% CI 2.0-4.0).Conclusions We found an association between drug exposure and SCLE. More than one third of the SCLE cases could be attributed to drug exposure. No significant OR was found for thiazides, which might be due to longer latency and therefore missed with this study design. DI-SCLE is reversible once the drug is discontinued, indicating the importance of screening patients with SCLE for potentially triggering drugs. A causal relationship cannot be established from this study and the underlying pathogenesis remains unclear.