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Published in: Archives of Dermatological Research 1/2019

01-01-2019 | Original Paper

Mortality and risk factors among Israeli bullous pemphigoid patients

Authors: Mati Rozenblat, Awad Halaj, Tal Rozenblat, Shani Fisher, Mohammad Sah, Roni P. Dodiuk-Gad, Michael Ziv

Published in: Archives of Dermatological Research | Issue 1/2019

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Abstract

There are differences concerning reported mortality rates and prognostic factors of bullous pemphigoid (BP) patients in different studies. Our objectives were to evaluate the mortality rates and prognostic factors among Israeli BP patients compared to matched control subjects. Three age- and sex-matched patients without BP (n = 261) who were treated in our clinic were selected and compared to BP patients (n = 87). Mean survival period of the BP group was 4.1 years (95% CI: 3.3–4.8 years) and 5.9 years among the non-BP group (95% CI: 5.6–6.3 years). The 1-year mortality rate was 24.1% for the BP group and 6.5% for the control group. In multivariate analysis, age above 80 was a significant risk factor for mortality [HR 3.22 (95% CI, 1.15–8.96), p = 0.03], while statins intake had a protective role [HR 0.36 (95% CI, 0.15–0.88), p = 0.03]. In univariant analysis, dementia [HR 2.44 (95% CI, 1.02–5.99), p = 0.04] was a risk factor. In conclusion, BP patients’ mortality is correlated to increasing age at diagnosis, dementia, and statins use. Statins’ protective role is newly discussed in the literature.
Literature
1.
go back to reference Bastuji-Garin S, Joly P, Lemordant P, Sparsa A, Bedane C, Delaporte E, Roujeau JC, Bernard P, Guillaume JC, Ingen-Housz-Oro S, Maillard H (2011) Risk factors for bullous pemphigoid in the elderly: a prospective case-control study. J Invest Dermatol 131(3):637–643PubMedCrossRef Bastuji-Garin S, Joly P, Lemordant P, Sparsa A, Bedane C, Delaporte E, Roujeau JC, Bernard P, Guillaume JC, Ingen-Housz-Oro S, Maillard H (2011) Risk factors for bullous pemphigoid in the elderly: a prospective case-control study. J Invest Dermatol 131(3):637–643PubMedCrossRef
2.
go back to reference Bernard P, Vaillant L, Labeille B, Bedane C, Arbeille B, Denoeux JP, Lorette G, Bonnetblanc JM, Prost C (1995) Incidence and distribution of subepidermal autoimmune bullous skin diseases in three French regions. Bullous diseases French study group. Arch Dermatol 131(1):48–52PubMedCrossRef Bernard P, Vaillant L, Labeille B, Bedane C, Arbeille B, Denoeux JP, Lorette G, Bonnetblanc JM, Prost C (1995) Incidence and distribution of subepidermal autoimmune bullous skin diseases in three French regions. Bullous diseases French study group. Arch Dermatol 131(1):48–52PubMedCrossRef
3.
go back to reference Brick KE, Weaver CH, Savica R, Lohse CM, Pittelkow MR, Boeve BF, Gibson LE, Camilleri MJ, Wieland CN (2014) A population-based study of the association between bullous pemphigoid and neurologic disorders. J Am Acad Dermatol 71(6):1191–1197PubMedPubMedCentralCrossRef Brick KE, Weaver CH, Savica R, Lohse CM, Pittelkow MR, Boeve BF, Gibson LE, Camilleri MJ, Wieland CN (2014) A population-based study of the association between bullous pemphigoid and neurologic disorders. J Am Acad Dermatol 71(6):1191–1197PubMedPubMedCentralCrossRef
4.
go back to reference Brick KE, Weaver CH, Lohse CM, Pittelkow MR, Lehman JS, Camilleri MJ, Al-Hashimi M, Wieland CN (2014) Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009. J Am Acad Dermatol 71(1):92–99PubMedPubMedCentralCrossRef Brick KE, Weaver CH, Lohse CM, Pittelkow MR, Lehman JS, Camilleri MJ, Al-Hashimi M, Wieland CN (2014) Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009. J Am Acad Dermatol 71(1):92–99PubMedPubMedCentralCrossRef
5.
go back to reference Brown A, Dalpé G, Mathieu M, Kothary R (1995) Cloning and characterization of the neural isoforms of human dystonin. Genomics 29(3):777–780PubMedCrossRef Brown A, Dalpé G, Mathieu M, Kothary R (1995) Cloning and characterization of the neural isoforms of human dystonin. Genomics 29(3):777–780PubMedCrossRef
6.
go back to reference Bystryn J-C, Rudolph JL (2005) Why Is the mortality of bullous pemphigoid greater in Europe than in the US? J Invest Dermatol 124(3):xx–xxiPubMedCrossRef Bystryn J-C, Rudolph JL (2005) Why Is the mortality of bullous pemphigoid greater in Europe than in the US? J Invest Dermatol 124(3):xx–xxiPubMedCrossRef
7.
go back to reference Chan D, Binks S, Nicholas JM, Frost C, Cardoso MJ, Ourselin S, Wilkie D, Nicholas R, Chataway J (2017) Effect of high-dose simvastatin on cognitive, neuropsychiatric, and health-related quality-of-life measures in secondary progressive multiple sclerosis: secondary analyses from the MS-STAT randomised, placebo-controlled trial. Lancet Neurol 16(8):591–600PubMedPubMedCentralCrossRef Chan D, Binks S, Nicholas JM, Frost C, Cardoso MJ, Ourselin S, Wilkie D, Nicholas R, Chataway J (2017) Effect of high-dose simvastatin on cognitive, neuropsychiatric, and health-related quality-of-life measures in secondary progressive multiple sclerosis: secondary analyses from the MS-STAT randomised, placebo-controlled trial. Lancet Neurol 16(8):591–600PubMedPubMedCentralCrossRef
8.
go back to reference Colbert RL, Allen DM, Eastwood D, Fairley JA (2004) Mortality rate of bullous pemphigoid in a US medical center. J Invest Dermatol 122(5):1091–1095PubMedCrossRef Colbert RL, Allen DM, Eastwood D, Fairley JA (2004) Mortality rate of bullous pemphigoid in a US medical center. J Invest Dermatol 122(5):1091–1095PubMedCrossRef
9.
go back to reference Cortés B, Marazza G, Naldi L, Comescure C, Borradori L, Autoimmune Bullous Disease Swiss Study Group (2011) Mortality of bullous pemphigoid in Switzerland: a prospective study. Br J Dermatol 165(2):368–374PubMedCrossRef Cortés B, Marazza G, Naldi L, Comescure C, Borradori L, Autoimmune Bullous Disease Swiss Study Group (2011) Mortality of bullous pemphigoid in Switzerland: a prospective study. Br J Dermatol 165(2):368–374PubMedCrossRef
10.
go back to reference Ferreira GA, Navarro TP, Telles RW, Andrade LE, Sato EI (2007) Atorvastatin therapy improves endothelial-dependent vasodilation in patients with systemic lupus erythematosus: an 8 weeks controlled trial. Rheumatology 46(10):1560–1565PubMedCrossRef Ferreira GA, Navarro TP, Telles RW, Andrade LE, Sato EI (2007) Atorvastatin therapy improves endothelial-dependent vasodilation in patients with systemic lupus erythematosus: an 8 weeks controlled trial. Rheumatology 46(10):1560–1565PubMedCrossRef
11.
go back to reference Gual A, Mascaró JM Jr, Rojas-Farreras S, Guilabert A, Julià M, Iranzo P (2012) Mortality of bullous pemphigoid in the first year after diagnosis: a retrospective study in a Spanish medical centre. J Eur Acad Dermatol Venereol 28(4):500–506PubMedCrossRef Gual A, Mascaró JM Jr, Rojas-Farreras S, Guilabert A, Julià M, Iranzo P (2012) Mortality of bullous pemphigoid in the first year after diagnosis: a retrospective study in a Spanish medical centre. J Eur Acad Dermatol Venereol 28(4):500–506PubMedCrossRef
12.
go back to reference Joly P, Roujeau JC, Benichou J, Picard C, Dreno B, Delaporte E, Vaillant L, D’Incan M, Plantin P, Bedane C, Young P, Bernard P, Bullous Diseases French Study Group (2002) A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 346(5):321–327PubMedCrossRef Joly P, Roujeau JC, Benichou J, Picard C, Dreno B, Delaporte E, Vaillant L, D’Incan M, Plantin P, Bedane C, Young P, Bernard P, Bullous Diseases French Study Group (2002) A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 346(5):321–327PubMedCrossRef
13.
go back to reference Joly P, Baricault S, Sparsa A, Bernard P, Bédane C, Duvert-Lehembre S, Courville P, Bravard P, Rémond B, Doffoel-Hantz V, Bénichou J (2012) Incidence and mortality of bullous pemphigoid in France. J Invest Dermatol 132(8):1998–2004PubMedCrossRef Joly P, Baricault S, Sparsa A, Bernard P, Bédane C, Duvert-Lehembre S, Courville P, Bravard P, Rémond B, Doffoel-Hantz V, Bénichou J (2012) Incidence and mortality of bullous pemphigoid in France. J Invest Dermatol 132(8):1998–2004PubMedCrossRef
14.
go back to reference Joly P, Benichou J, Saiag P, Bernard P, Roujheu JC (2005) Response to: mortality rate of bullous pemphigoid in a US medical center. J Invest Dermatol 124(3):664–665PubMedCrossRef Joly P, Benichou J, Saiag P, Bernard P, Roujheu JC (2005) Response to: mortality rate of bullous pemphigoid in a US medical center. J Invest Dermatol 124(3):664–665PubMedCrossRef
15.
go back to reference Jung M, Kippes W, Messer G, Zillikens D, Rzany B (1999) Increased risk of bullous pemphigoid in male and very old patients: A population-based study on incidence. J Am Acad Dermatol 41(2 Pt 1):266–268PubMedCrossRef Jung M, Kippes W, Messer G, Zillikens D, Rzany B (1999) Increased risk of bullous pemphigoid in male and very old patients: A population-based study on incidence. J Am Acad Dermatol 41(2 Pt 1):266–268PubMedCrossRef
16.
go back to reference Kalinska-Bienias A, Lukowska-Smorawska K, Jagielski P, Kowalewski C, Rozniak K (2017) Mortality in bullous pemphigoid and prognostic factors in 1st and 3rd year of follow-up in specialized centre in Poland. Arch Dermatol Res 309(9):709–719PubMedCrossRef Kalinska-Bienias A, Lukowska-Smorawska K, Jagielski P, Kowalewski C, Rozniak K (2017) Mortality in bullous pemphigoid and prognostic factors in 1st and 3rd year of follow-up in specialized centre in Poland. Arch Dermatol Res 309(9):709–719PubMedCrossRef
17.
go back to reference Kanate AS, Hari PN, Pasquini MC, Visotcky A, Ahn KW, Boyd J, Guru Murthy GS, Rizzo JD, Saber W, Drobyski W, Michaelis L, Atallah E, Carlson KS, D’Souza A, Fenske TS, Cumpston A, Bunner P, Craig M, Horowitz MM, Hmadani M (2017) Recipient immune modulation with atorvastatin for acute graft-versus-host disease prophylaxis after allogeneic transplantation. Biol Blood Marrow Transpl 23(8):1295–1302CrossRef Kanate AS, Hari PN, Pasquini MC, Visotcky A, Ahn KW, Boyd J, Guru Murthy GS, Rizzo JD, Saber W, Drobyski W, Michaelis L, Atallah E, Carlson KS, D’Souza A, Fenske TS, Cumpston A, Bunner P, Craig M, Horowitz MM, Hmadani M (2017) Recipient immune modulation with atorvastatin for acute graft-versus-host disease prophylaxis after allogeneic transplantation. Biol Blood Marrow Transpl 23(8):1295–1302CrossRef
18.
go back to reference Kridin K, Bergman R (2018) Ethnic variations in the epidemiology of bullous pemphigoid in Israel. Int J Dermatol 57(1):34–39PubMedCrossRef Kridin K, Bergman R (2018) Ethnic variations in the epidemiology of bullous pemphigoid in Israel. Int J Dermatol 57(1):34–39PubMedCrossRef
19.
go back to reference Lee JH, Kim S-C (2014) Mortality of patients with bullous pemphigoid in Korea. J Am Acad Dermatol 71(4):676–683PubMedCrossRef Lee JH, Kim S-C (2014) Mortality of patients with bullous pemphigoid in Korea. J Am Acad Dermatol 71(4):676–683PubMedCrossRef
20.
go back to reference Li J, Zuo YG, Zheng HY (2013) Mortality of bullous pemphigoid in China. JAMA Dermatol 149(1):106–108PubMedCrossRef Li J, Zuo YG, Zheng HY (2013) Mortality of bullous pemphigoid in China. JAMA Dermatol 149(1):106–108PubMedCrossRef
21.
go back to reference Liu YD, Wang YH, Ye YC, Zhao WL, Li L (2017) Prognostic factors for mortality in patients with bullous pemphigoid: a meta-analysis. Arch Dermatol Res 309(5):335–347PubMedPubMedCentralCrossRef Liu YD, Wang YH, Ye YC, Zhao WL, Li L (2017) Prognostic factors for mortality in patients with bullous pemphigoid: a meta-analysis. Arch Dermatol Res 309(5):335–347PubMedPubMedCentralCrossRef
22.
go back to reference Mowla K, Rajai E, Ghorbani A, Dargahi-Malamir M, Bahadoram M, Mohammadi S (2016) Effect of atorvastatin on the disease activity and severity of rheumatoid arthritis: double-blind randomized controlled trial. J Clin Diagn Res 10(5):OC32–OC36PubMedPubMedCentral Mowla K, Rajai E, Ghorbani A, Dargahi-Malamir M, Bahadoram M, Mohammadi S (2016) Effect of atorvastatin on the disease activity and severity of rheumatoid arthritis: double-blind randomized controlled trial. J Clin Diagn Res 10(5):OC32–OC36PubMedPubMedCentral
23.
go back to reference Parker SR, Dyson S, Brisman S, Pennie M, Swerlick RA, Khan R, Manos S, Korman BD, Xia Z, Korman NJ (2008) Mortality of bullous pemphigoid: an evaluation of 223 patients and comparison with the mortality in the general population in the United States. J Am Acad Dermatol 59(4):582–588PubMedCrossRef Parker SR, Dyson S, Brisman S, Pennie M, Swerlick RA, Khan R, Manos S, Korman BD, Xia Z, Korman NJ (2008) Mortality of bullous pemphigoid: an evaluation of 223 patients and comparison with the mortality in the general population in the United States. J Am Acad Dermatol 59(4):582–588PubMedCrossRef
24.
go back to reference Risser J, Lewis K, Weinstock MA (2009) Mortality of bullous skin disorders from 1979 through 2002 in the United States. Arch Dermatol 145(9):1005–1008PubMedCrossRef Risser J, Lewis K, Weinstock MA (2009) Mortality of bullous skin disorders from 1979 through 2002 in the United States. Arch Dermatol 145(9):1005–1008PubMedCrossRef
25.
go back to reference Roujeau JC, Lok C, Bastuji-Garin S, Mhalla S, Enginger V, Bernard P (1998) High risk of death in elderly patients with extensive bullous pemphigoid. Arch Dermatol 134(4):465–469PubMedCrossRef Roujeau JC, Lok C, Bastuji-Garin S, Mhalla S, Enginger V, Bernard P (1998) High risk of death in elderly patients with extensive bullous pemphigoid. Arch Dermatol 134(4):465–469PubMedCrossRef
26.
go back to reference Rzany B, Partscht K, Jung M, Kippes W, Mecking D, Baima B, Prudio CM, Pawelczyk B, Messmer EM, Schuhmann M, Sinkgraven R et al (2002) Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticosteroids, and old age. Arch Dermatol 138(7):903–908PubMedCrossRef Rzany B, Partscht K, Jung M, Kippes W, Mecking D, Baima B, Prudio CM, Pawelczyk B, Messmer EM, Schuhmann M, Sinkgraven R et al (2002) Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticosteroids, and old age. Arch Dermatol 138(7):903–908PubMedCrossRef
28.
go back to reference Vaillant L, Bernard P, Joly P, Prost C, Labeille B, Bedane C, Arbeille B, thomine E, Bertrand P, Lok C, Roujeau JC (1998) Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French bullous study group. Arch Dermatol 134(9):1075–1080PubMedCrossRef Vaillant L, Bernard P, Joly P, Prost C, Labeille B, Bedane C, Arbeille B, thomine E, Bertrand P, Lok C, Roujeau JC (1998) Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French bullous study group. Arch Dermatol 134(9):1075–1080PubMedCrossRef
Metadata
Title
Mortality and risk factors among Israeli bullous pemphigoid patients
Authors
Mati Rozenblat
Awad Halaj
Tal Rozenblat
Shani Fisher
Mohammad Sah
Roni P. Dodiuk-Gad
Michael Ziv
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Dermatological Research / Issue 1/2019
Print ISSN: 0340-3696
Electronic ISSN: 1432-069X
DOI
https://doi.org/10.1007/s00403-018-1875-z

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