Proton pump inhibitors associated with signals for drug-induced lupus
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Proton pump inhibitors may be associated with pharmacovigilance signals for the occurrence of drug-induced lupus erythematosus, according to a research letter published in JAMA Dermatology.
“The role of proton pump inhibitors (PPIs) in the occurrence of drug-induced lupus erythematosus (DILE) has been suggested for both drug-induced systemic lupus erythematosus (DI-SLE) and drug-induced cutaneous lupus erythematosus (DI-CLE) but remains poorly characterized,” Pauline Bataille, MD, of Sorbonne University, in Paris, and co-authors wrote.
To investigate the connection between proton pump inhibitors and DILE, Bataille and colleagues analyzed data from the WHO’s global pharmacovigilance database, VigiBase. They also examined data from the French pharmacovigilance database, and conducted a case-non-case study for every proton pump inhibitor and molecule to assess potential pharmacovigilance signals and their associations with DILE. They included DILE cases reported by a physician after Jan. 1, 2002, in the analysis.
In addition to the case analyses, the researchers described the “clinical, immunological and therapeutic,” management of suspected proton pump inhibitor-associated DILE. They conducted data analysis from December 2019 through September 2021.
The VigiBase database included a total of 21,104,559 cases that were reported between January 1995 and December 2019, among which 625 were identified as DILE associated with a proton pump inhibitor, according to the researchers. In 307 of these cases, a proton pump inhibitor was the only drug suspected. Omeprazole (Prilosec, Proctor and Gamble) was the proton pump inhibitor most often involved, at 30.4% of cases.
Meanwhile, the analysis of the French database yielded 60 cases of proton pump inhibitor-associated DILE, of which 49 were included for analysis following review. Esomeprazole (Nexium, GlaxoSmithKline) was the most common inhibitor in this group, and was involved in 46.9% of cases. Treatment was ended in 35 of 41 patients. Among these 35 patients, 51.4% achieved disease remission with no specific treatment.
“This descriptive case series highlights that, first, PPIs may be associated with not only isolated DI-CLE, but also DI-SLE with or without cutaneous involvement,” Bataille and colleagues wrote. “Second, among DI-CLE cases, subacute CLE is the most common subtype in contrast with discoid CLE in the general population. Finally, we also identified two cases of discoid CLE and one case of tumidus lupus, which emphasizes that other CLE subtypes may be associated with PPIs.”
References:
- Arnould L, et al. Ann Rheum Dis. 2019;doi: 10.1136/annrheumdis-2018-214598.
- Kawka L, et al. Autoimmun Rev. 2021;doi: 10.1016/j.autrev.2020.102705.
- Sandholdt LH, et al. Br J Dermatol. 2014;doi: 10.1111/bjd.12699.
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