Mortality and Comorbidity Profiles of Patients with Bullous Pemphigoid in Korea

Jeon, Hyeon Woo; Yun, Sook Jung; Lee, Seung−Chul; Won, Young Ho; Lee, Jee-Bum

doi:10.5021/ad.2018.30.1.13

Cited by 28 publications

(42 citation statements)

References 45 publications

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“…Our results show that patients with pemphigus who were over 60 years old and have a higher CCI index level had higher risks of overall mortality, which were in agreement with previous similar studies ( Baican et al, 2015 ; Jeon et al, 2018 ). Older age and the presence of more comorbidities were associated with higher risks of overall mortality as observed in Bullous pemphigoid ( Jeon et al, 2018 ).…”

Section: Discussionsupporting

confidence: 93%

Complementary Chinese Herbal Medicine Therapy Improves Survival in Patients With Pemphigus: A Retrospective Study From a Taiwan-Based Registry

Shui

et al. 2020

Front. Pharmacol.

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Pemphigus is a life-threatening and skin-specific inflammatory autoimmune disease, characterized by intraepidermal blistering between the mucous membranes and skin. Chinese herbal medicine (CHM) has been used as an adjunct therapy for treating many diseases, including pemphigus. However, there are still limited studies in effects of CHM treatment in pemphigus, especially in Taiwan. To more comprehensively explore the effect of long-term CHM treatment on the overall mortality of pemphigus patients, we performed a retrospective analysis of 1,037 pemphigus patients identified from the Registry for Catastrophic Illness Patients database in Taiwan. Among them, 229 and 177 patients were defined as CHM users and non-users, respectively. CHM users were young, predominantly female, and had a lesser Charlson comorbidity index (CCI) than non-CHM users. After adjusting for age, sex, prednisolone use, and CCI, CHM users had a lower overall mortality risk than non-CHM users (multivariate model: hazard ratio (HR): 0.422, 95% confidence interval (CI): 0.242–0.735, p = 0.0023). The cumulative incidence of overall survival was significantly higher in CHM users than in non-users (p = 0.0025, log rank test). Association rule mining and network analysis showed that there was one main CHM cluster with Qi–Ju–Di–Huang–Wan (QJDHW), Dan–Shen (DanS; Radix Salviae miltiorrhizae; Salvia miltiorrhiza Bunge), Jia–Wei–Xiao–Yao-–San (JWXYS), Huang–Lian (HL; Rhizoma coptidis; Coptis chinensis Franch.), and Di–Gu–Pi (DGP; Cortex lycii; Lycium barbarum L.), while the second CHM cluster included Jin–Yin–Hua (JYH; Flos lonicerae; Lonicera hypoglauca Miq.) and Lian–Qiao (LQ; Fructus forsythiae; Forsythia suspensa (Thunb.) Vahl). In Taiwan, CHMs used as an adjunctive therapy reduced the overall mortality to approximately 20% among pemphigus patients after a follow-up of more than 6 years. A comprehensive CHM list may be useful in future clinical trials and further scientific investigations to improve the overall survival in these patients.

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Section: Discussionsupporting

confidence: 93%

Complementary Chinese Herbal Medicine Therapy Improves Survival in Patients With Pemphigus: A Retrospective Study From a Taiwan-Based Registry

Shui

et al. 2020

Front. Pharmacol.

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“…2 Although the exact pathogenesis of BP remains unknown, neurologic disorders (eg, dementia and Parkinson disease), psychiatric disorders, inflammatory skin diseases, and conditions associated with being bedridden are considered to be risk factors of BP. [3][4][5][6] Various factors (eg, trauma, burns, radiotherapy, and drugs) may be involved in the development of BP. 1 Dipeptidyl peptidase 4 (DPP-4) inhibitors are a new class of oral antidiabetic agents for patients with type 2 diabetes that can be used alone or in combination with metformin.…”

mentioning

confidence: 99%

Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes

et al. 2019

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IMPORTANCE Recent studies suggest that dipeptidyl peptidase 4 (DPP-4) inhibitors are associated with an increased risk of developing bullous pemphigoid (BP). Population-based studies on the association between DPP-4 inhibitors and BP are limited. OBJECTIVE To characterize the potential association between the use of DPP-4 inhibitors and an increased risk of developing BP. DESIGN, SETTING, AND PARTICIPANTS This retrospective, nationwide, population-based, case-control study using Korean insurance claims data from January 1, 2012, to December 31, 2016, included patients with newly diagnosed BP and diabetes. Control patients with diabetes (and without BP) were randomly obtained after matching for age, sex, and year of diagnosis within the same period. MAIN OUTCOMES AND MEASURES The number of patients with newly diagnosed BP and diabetes per year and annual changes in the proportion of patients with diabetes among all patients with BP were measured. The association between use of DPP-4 inhibitors and risk of developing BP was analyzed using univariate and multivariate logistic regression analyses. RESULTS The study included 670 case patients (with diabetes and BP) and 670 control patients (with only diabetes) (mean [SD] age, 75.3 [10.0] years in each group; 342 [51.0%] male in each group). The number of patients with diabetes and BP more than doubled during the study period (from 77 in 2012 to 206 in 2016). The proportion of patients with diabetes among all patients with BP also increased (from 0.18 in 2012 to 0.33 in 2016). The use of DPP-4 inhibitors was associated with a significant increase in the risk of developing BP (adjusted odds ratio [aOR], 1.58; 95% CI, 1.25-2.00; P < .001); among all DPP-4 inhibitors used in Korea, the highest aOR was associated with the use of vildagliptin (aOR, 1.81; 95% CI, 1.31-2.50; P < .001). Subgroup analyses revealed a significant association in male patients (aOR, 1.91; 95% CI, 1.39-2.63; P < .001) and that vildagliptin was the most high-risk DPP-4 inhibitor (aOR, 2.70; 95% CI, 1.73-4.34; P < .001). CONCLUSIONS AND RELEVANCE The findings suggest that DPP-4 inhibitors are associated with a significantly increased risk of the development of BP in patients with diabetes. Of the DPP-4 inhibitors available in Korea, vildagliptin was associated with the highest risk, particularly in male patients. Practitioners should consider that DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of BP in patients with diabetes. These nationwide, population-based results may serve as a foundation for further studies seeking to understand how DPP-4 inhibitors contribute to the development of BP.

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“…This study of Finnish BP patients reveals a strong association between DH and BP. Neither DH nor CD were analyzed in previous studies of BP comorbidities (Bastuji-Garin et al, 2011;Chen et al, 2011;Jedlickova et al, 2010;Jeon et al, 2018;Kibsgaard et al, 2017;Sim et al, 2017;Teixeira et al, 2014). In a British interview-based study of BP and other autoimmune disorders, neither DH nor CD were among the diseases about which the participants (n ¼ 108) were asked (Taylor et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

Dermatitis Herpetiformis and Celiac Disease Increase the Risk of Bullous Pemphigoid

Varpuluoma

Jokelainen

Försti

et al. 2019

Journal of Investigative Dermatology

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Bullous pemphigoid (BP) and dermatitis herpetiformis (DH) are autoimmune bullous skin diseases. DH has been described to evolve into BP and the two diseases can have overlapping clinical appearances and diagnostic findings, but the association between DH and BP has not previously been studied in a large population. To evaluate DH and celiac disease as risk factors for BP, we conducted a retrospective case-control study of patients with BP and matched controls with basal cell carcinoma diagnosed in Finland between 1997 and 2013. A total of 3,397 patients with BP and 12,941 controls were included in the study. Forty-one (1.2%) BP patients and 7 (0.1%) controls had preceding DH. Diagnosed DH increased the risk of BP 22-fold (odds ratio ¼ 22.30; 95% confidence interval ¼ 9.99e49.70) and celiac disease 2-fold (odds ratio ¼ 2.54; 95% confidence interval ¼ 1.64e3.92) compared to controls. Eighteen (43.9%) of the patients who had DH and subsequent BP had bought dapsone during the 2 years prior to their BP diagnosis. Mean time between diagnosed DH and BP was 3 years. We conclude that diagnosis of DH is associated with a striking increase in the risk for BP.

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Mortality and Comorbidity Profiles of Patients with Bullous Pemphigoid in Korea

Cited by 28 publications

References 45 publications

Complementary Chinese Herbal Medicine Therapy Improves Survival in Patients With Pemphigus: A Retrospective Study From a Taiwan-Based Registry

Complementary Chinese Herbal Medicine Therapy Improves Survival in Patients With Pemphigus: A Retrospective Study From a Taiwan-Based Registry

Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes

Dermatitis Herpetiformis and Celiac Disease Increase the Risk of Bullous Pemphigoid

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