Drug-induced lupus is a constantly evolving disease

The list of medicines suspected of causing drug-induced lupus maybe useful to doctors for diagnosis and management of people with this disease.

Systemic lupus erythematosus (often shortened to SLE) is an autoimmune disease. It typically affects women between the ages of 15 and 45. The exact cause of the disease is unknown, but occasionally lupus can be triggered by the use of medicines (called drug-induced lupus).

Lupus often causes certain cells in the body to become hyperactive and increase the production of autoantibodies. Symptoms vary from person to person, but people with lupus are often tired and may have fever, joint pain and rashes that are sensitive to sunlight.

What did the authors hope to find?
The authors wanted to learn more about drug-induced lupus, and work out which medicines might cause it.

How was the study conducted?
When medicines cause side effects, doctors report the details to the authorities. The information is collected in databases that can look for links and patterns. This study looked at individual case safety reports in Vigibase, a large database run by the World Health Organization (often shortened to ‘WHO’) that collects information for 90% of the world population. The authors used this database to find information on medicines linked to lupus. In total, they looked at over 12,000 case safety reports.

What were the main findings of the study?
The study found 118 medicines that might be linked to drug-induced lupus. Of these, 42 had not been linked to lupus before. The medicines associated with the highest number of cases of drug induced lupus were infliximab, adalimumab, etanercept, procainamide and hydralazine. Based on the literature review, it was decided that there was a definite relationship for only 9 drugs (procainamide, hydralazine, minocycline, quinidine, isoniazid, terbinafine, methyldopa, dihydralazine and chlorpromazine), a probable relationship for 19 drugs and a possible relationship for another 45 drugs.

The authors also found that drug-induced lupus often starts a bit later in life than other types of lupus – on average at the age of 49 – but still affects women more frequently than men.

Are these findings new?
Yes – several of the medicines identified in this study had not been linked to drug-induced lupus before.

What are the limitations of the study?
The most important limitation of this study is that cases of drug-induced lupus may not have been reported to Vigibase. Also, it is important to be aware that a positive signal in a database does not necessarily mean the drug is the cause. Any interesting signals that suggest there might be a safety issue with a drug should be confirmed in specific studies.

What do the authors plan on doing with this information?
These results will be used to help improve the diagnosis of SLE and separate it from drug-induced lupus.

What does this mean for me?
If you have drug-induced lupus, it is important to work out which drug is causing it, since once the drug is removed the lupus will go away.

If you are concerned that your lupus might be drug-related, you should speak to your doctor before you stop taking any medicines.

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Date prepared: April 2019
Summary based on research article published on: 4 February 2019
From: Arnaud L, et al. Drug-induced systemic lupus: revisiting the ever-changing spectrum of the disease using the WHO pharmacovigilance database.
Ann Rheum Dis 2019;78:504–508. doi:10.1136/annrheumdis-2018-214598

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