| アブストラクト | BACKGROUND: Bullous pemphigoid (BP) is an autoimmune skin disease that mainly affects older people. Based on case series and small hospital-based studies, a number of drugs have been associated with BP. More reliable and precise estimates of associations between a broad selection of drugs/vaccines and BP will enable greater awareness of any potential increased risk of BP following the administration of certain medicines and help identify clinical, histological and genomic characteristics of drug-induced BP for different culprit drugs. Greater awareness could lead to earlier recognition or suspicion of BP and referral to a dermatologist for diagnosis. Earlier diagnosis may lead to less aggressive treatment and improved wellbeing. OBJECTIVES: To determine the association between drugs/vaccines commonly prescribed to older people and the risk of developing BP. METHODS: We conducted a population-based nested case-control study between 1998 and 2021 using electronic primary care records from the Clinical Practice Research Datalink. We matched patients with BP with up to five controls. Exposures were drugs/vaccines commonly prescribed to older people. We used multivariable conditional logistic regression adjusting for multiple drug use. For antibiotics, in a sensitivity analysis, we considered that drugs may be prescribed for undiagnosed symptoms of BP that resemble skin infection (protopathic bias). RESULTS: Antibiotics were associated with the highest risk of BP [odds ratio (OR) 4.60, 95% confidence interval (CI) 4.40-4.80]. However, after adjusting for protopathic bias, the OR decreased to 2.08 (95% CI 1.99-2.17). Also, after adjusting for protopathic bias, of all the antibiotic classes and subclasses, penicillins [OR 3.44, 95% CI 3.29-3.60 (sensitivity analysis OR 1.74, 95% CI 1.66-1.84)] and penicillinase-resistant penicillins [OR 7.56, 95% CI 7.15-8.00 (sensitivity analysis OR 2.64, 95% CI 2.45-2.85)] had the strongest associations with BP risk. Other drugs strongly associated with increased risk were gliptins (OR 2.77, 95% CI 2.37-3.23) and second-generation antipsychotics (OR 2.58, 95% CI 2.20-3.03). CONCLUSIONS: Healthcare professionals need to be aware of BP risk in older people, particularly when prescribing penicillinase-resistant penicillins, gliptins and second-generation antipsychotic drugs, to recognize and manage BP early. Owing to the low disease prevalence, we do not suggest avoiding certain drugs/vaccines to prevent BP. Further research should consider recency, dosage and duration of antibiotic treatments. |
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| ジャーナル名 | The British journal of dermatology |
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| Pubmed追加日 | 2024/10/29 |
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| 投稿者 | Swiderski, Mikolaj; Vinogradova, Yana; Knaggs, Roger D; Harman, Karen; Harwood, Rowan H; Prasad, Vibhore; Persson, Monica S M; Figueredo, Grazziela; Layfield, Carron; Gran, Sonia |
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| 組織名 | School of Medicine, University of Nottingham, Nottingham, UK.;School of Pharmacy, University of Nottingham, Nottingham, UK.;Department of Dermatology, University Hospitals of Leicester NHS Trust,;Leicester, UK.;School of Health Sciences, University of Nottingham, Nottingham, UK.;King's College London, London, UK.;NHS Nottinghamshire, Nottingham, UK.;Swedish Rheumatism Association, Stockholm, Sweden.;School of Computer Science, University of Nottingham, Nottingham, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/39467333/ |
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