Abstract
Introduction
Several case studies have reported an association between antifungal drug use and psoriasis risk.
Objective
The objective of this study was to investigate the association between terbinafine/itraconazole exposure and psoriasis incidence.
Methods
Among patients with onychomycosis in the Taiwan National Health Insurance Research Database, 3831 incident psoriasis cases were identified during 2004–2010 and compared with 3831 age- and sex-matched controls with the same look-back period. Multivariate conditional logistic regression was used for the analysis.
Results
The psoriasis cases were significantly more likely than matched controls to have used terbinafine or itraconazole (59.85 vs. 42.70%, respectively; p < 0.0001). After adjusting for potential confounders and cumulative duration of antifungal drug prescription, terbinafine/itraconazole use was associated with an increased psoriasis risk (adjusted odds ratio 1.33, 95% confidence interval 1.15–1.54). The association was stronger for more recent drug exposure (adjusted odds ratio 2.96, 95% confidence interval 2.25–3.90 for ≤ 90 days before the sampling date; adjusted odds ratio 1.04, 95% confidence interval 0.89–1.22 for > 360 days). In a comparison of patients receiving terbinafine or itraconazole only, psoriasis risk was higher for itraconazole (adjusted odds ratio 1.21, 95% confidence interval 1.05–1.40).
Conclusion
This large population-based case-control analysis showed that exposure to terbinafine or itraconazole is associated with an increased risk of incident psoriasis. The finding of an increased psoriasis risk for antifungal drug users, particularly for itraconazole, deserves attention in clinical practice although further prospective studies are necessary to confirm our findings and clarify the biological mechanisms that underlie these associations.
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Acknowledgements
We thank Prof. Weng-Foung Huang and the National Health Research Institutes for providing data. This study is based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, Ministry of Health and Welfare or National Health Research Institutes.
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Conception and design: H-YC, W-LC, T-FT, Y-WT, M-NS. Acquisition of data: W-LC, Y-WT, M-NS. Analysis and interpretation of the data: H-YC, W-LC, T-FT, Y-WT, M-NS. Drafting of the article: H-YC, W-LC, T-FT. Critical revision of the article for important intellectual content: T-FT, Y-WT, M-NS. Obtaining of funding: H-YC, T-FT. Final approval of the article: H-YC, W-LC, T-FT, Y-WT, M-NS.
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This study was funded in part by grants from National Taiwan University Hospital (105-S3196), National Taiwan University Hospital Hsin-Chu branch (106-HCH002), and the Ministry of Science and Technology, Taiwan (formerly, the National Science Council; grant numbers, MOST104-2314-B-002-117-MY3). The researchers were independent of the funders in designing the study, collecting and analyzing the data, interpreting the results, writing the manuscript, and deciding to submit the article for publication.
Conflict of interest
Wei-Lun Chang, Yi-Wen Tsai, and Ming-Neng Shiu have no conflicts of interest directly relevant to the content of this study. Hsien-Yi Chiu has received speaking fees from AbbVie, Janssen-Cilag Pharmaceutical, Novartis, and Pfizer. Tsen-Fang Tsai has conducted clinical trials or received honoraria for serving as a consultant for Pfizer, Eli Lilly, Galderma, Celgene, Novartis, and Janssen-Cilag Pharmaceutical and has received speaking fees from AbbVie.
Ethics approval
The study protocol was reviewed and approved by the local Institutional Review Board of National Taiwan University Hospital, Hsin-Chu, Taiwan (No. 103-024-E).
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Chiu, HY., Chang, WL., Tsai, TF. et al. Risk of Psoriasis Following Terbinafine or Itraconazole Treatment for Onychomycosis: A Population-Based Case-Control Comparative Study. Drug Saf 41, 285–295 (2018). https://doi.org/10.1007/s40264-017-0614-2
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DOI: https://doi.org/10.1007/s40264-017-0614-2