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The relationship between pemphigus and systemic lupus erythematosus: a cross-sectional study, systematic review, and meta-analysis

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Abstract

The coexistence of pemphigus and systemic lupus erythematosus (SLE) had been reported anecdotally. Anti-desmoglein (Dsg)1 and anti-Dsg3 antibodies were detected concomitantly with antinuclear autoantibodies among blood donors. The aim of the current study was to study the association between pemphigus and SLE in Israeli patients and to synthesize existing data on this association in the current literature. The current study included two sections. Initially, a cross-sectional study was performed to compare pemphigus patients with age-, sex-, and ethnicity-matched control subjects regarding the prevalence of SLE using a real-life large-scale computerized database. Next, a systematic review and meta-analysis of similar observational studies in Medline, Embase, and Web of Science (1823–2017) was conducted. As for the cross-sectional study, a total of 1985 patients with pemphigus and 9874 controls were included in the study. The prevalence of SLE was slightly higher among patients with pemphigus as compared to controls (OR, 1.85; 95% CI, 0.89–3.82). In a sensitivity analysis that included patients who received pemphigus-related treatments, the association between pemphigus and SLE had been substantiated and was statistically significant (OR, 2.10; 95% CI, 1.00–4.48). In the meta-analysis section, three eligible studies, comprising 10,389 pemphigus patients met the eligibility criteria. The overall pooled multivariate OR was 2.50 (95% CI 1.54–4.07, I2 = 44.19%, P = 0.167) across all studies. In conclusion, the meta-analysis provides epidemiologic evidence that these B cell-driven diseases are significantly associated. Further research is required to elucidate the molecular mechanism underlying this association.

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Authors and Affiliations

  1. Department of Dermatology, Rambam Health Care Campus, POB 9602, 31096, Haifa, Israel

    Khalaf Kridin & Rimma Laufer-Britva

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Mouhammad Kridin

  3. Department of Quality Measurements and Research, Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel

    Doron Comaneshter, Erez Batat & Arnon D. Cohen

  4. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Arnon D. Cohen

Authors
  1. Khalaf Kridin
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  2. Rimma Laufer-Britva
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  3. Mouhammad Kridin
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  4. Doron Comaneshter
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  5. Erez Batat
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  6. Arnon D. Cohen
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Correspondence to Khalaf Kridin.

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Conflict of interests

Prof. Arnon Cohen received research grants from Janssen, Novartis, AbbVie, Janssen, and Sanofi. Prof. Arnon Cohen served as a consultant, advisor, or speaker to AbbVie, Amgen, Boehringer Ingelheim, Dexcel pharma, Janssen, Kamedis, Lilly, Neopharm, Novartis, Perrigo, Pfizer, Rafa, Samsung Bioepis, Sanofi, Sirbal, and Taro. No funding was gained for the research.

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Supplementary Table 1

Literature search strategy for each one the databases examined (DOCX 16 kb)

Supplementary Figure 1

Funnel plot for all the included studies. (DOCX 16 kb)

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Kridin, K., Laufer-Britva, R., Kridin, M. et al. The relationship between pemphigus and systemic lupus erythematosus: a cross-sectional study, systematic review, and meta-analysis. Immunol Res 67, 116–122 (2019). https://doi.org/10.1007/s12026-019-9065-4

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  • DOI: https://doi.org/10.1007/s12026-019-9065-4

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