List of drugs that may induce lupus erythematosus grows

Many drugs can induce cutaneous or systemic lupus erythematosus, and physicians should be aware of the evolving drug association list, according to a study.

“Drug-induced lupus erythematosus (DILE) is best defined as an adverse reaction of treatment with a certain drug taken continuously over time, inducing lupus-like symptoms,” Jeanette Halskou Haugaard, MD, and colleagues wrote.

The observational case-control study included 3,148 patients with cutaneous lupus erythematosus (CLE) or systemic lupus erythematosus (SLE), and 31,480 matched controls from the general population in Denmark. A screening process for drug exposure in all CLE or SLE cases was conducted, which included drugs filled at all Danish pharmacies, as well as registered treatments from hospitals.

If a specific drug or drug class was prescribed to at least 100 cases, the drug was included in the analyses.

Potentially new associations were identified with metoclopramide hydrochloride and levothyroxine sodium for SLE and metronidazole hydrochloride and fexofenadine hydrochloride for CLE and SLE.

“Our findings raise the important questions of whether the suspected drugs reported in the growing number of published case reports have an increased risk of inducing DILE or whether they are reflecting publication or protopathic bias,” the authors wrote.

The study’s limitations included the inability to conclude on causality and the risk for protopathic bias.

“The list of drugs reported to induce DILE is constantly changing as new drugs arise,” the authors wrote. “Therefore, it is important that physicians are updated on the changing drug list and remain aware of potential new drug associations, but at the same time, they must be aware of publication and protopathic bias.”