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Table of Contents
Year : 2021  |  Volume : 39  |  Issue : 3  |  Page : 153-154

Statins did not reduce the mortality risk in patients with bullous pemphigoid: A population-based cohort study

1 Department of Dermatology, Taipei Veterans General Hospital; Department of Dermatology; Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei; Department of Public Health, Institute of Public Health, National Yang Ming Chiao Tung University, Taiwan
2 Instititue of Biomedical Informatics, National Yang-Ming University; Division of Translational Research, Taipei Veterans General Hospital, Taipei; Graduate Institute of Clinical Medicine, China Medical University Taichung, Taiwan
3 Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
4 Department of Dermatology, Taipei Veterans General Hospital; Department of Dermatology, National Yang-Ming University, Taipei, Taiwan

Date of Submission10-Nov-2020
Date of Decision08-Mar-2021
Date of Acceptance09-Mar-2021
Date of Web Publication19-Jul-2021

Correspondence Address:
Dr. Chen-Yi Wu
Department of Dermatology, Taipei Veterans General Hospital; 201, Sec. 2, Shih-Pai Road, Taipei
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_14_21

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How to cite this article:
Wu CY, Wu CY, Lin YH, Chang YT. Statins did not reduce the mortality risk in patients with bullous pemphigoid: A population-based cohort study. Dermatol Sin 2021;39:153-4

How to cite this URL:
Wu CY, Wu CY, Lin YH, Chang YT. Statins did not reduce the mortality risk in patients with bullous pemphigoid: A population-based cohort study. Dermatol Sin [serial online] 2021 [cited 2021 Dec 6];39:153-4. Available from: https://www.dermsinica.org/text.asp?2021/39/3/153/321873

Dear Editor,

Bullous pemphigoid (BP) is the most common autoimmune bullous disease that primarily affects the elderly with considerable morbidity and mortality. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, were reported to be preventive against the development of BP.[1],[2] Rozenblat et al. first reported the statins' protective role in BP mortality.[3] However, the study only evaluated BP patients versus normal controls and not between BP patients. Therefore, we conducted a population-based cohort study to investigate whether statins play a protective role in the mortality of BP patients.

This nationwide study cohort was established by enrolling patients with BP between 1997 and 2010 from the National Health Insurance Research Database, which is a mandatory national health insurance program covering more than 99% of the Taiwanese population. Individuals were identified as BP patients if they satisfy at least three diagnostic codes (International Classification of Diseases, Ninth Revision, Clinical Modification code: 695.4) in their outpatient clinic records or one in their admission records. In these patients, statin users were defined as those who had statin intake for 28 days per month for 3 consecutive months. The last date of statin intake was labeled as the index date. BP patients who never used statins were defined as statin nonusers and a pseudo-index date was allocated with the same disease duration as with statin users. Statin users were randomly matched 1:4 with the statin nonusers by means of age at index date (±3 year), sex, propensity scores (±0.1) of comorbidities [listed in Supplementary [Table 1], except hyperlipidemia], and use of immunosuppressants, tetracyclines, and systemic corticosteroids. All enrolled subjects were followed up from the index date until death or up to December 31, 2013. This study was approved by the Institutional Review Board of the Taipei Veterans General Hospital (VGHIRB2019-01-007AC).
Table 1: Mortality risk in bullous pemphigoid patients

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Among BP patients, a total of 519 statin users and 2076 statin nonusers were identified [Supplementary Table 1]. There was no significant difference of the age at the index date, comorbidities, and use of systemic corticosteroids, immunosuppressants, and tetracyclines between these two groups. Among these 519 statin users, the mean follow-up time was 3.2 years, and the average duration of statin usage was 687.9 days (median: 422 days, interquartile range 224–872 days). The raw mortality rate is lower in the statin users, which were 191 (36.8%) in statin users and 1221 (58.8%) in statin nonusers. However, in the multivariable Cox hazards model adjusted for covariates, the mortality risk was not significantly different from that of statin nonusers (hazard ratio: 1.08, 95% confidence interval: 0.99–1.17, P = 0.08) [Table 1]. Age, diabetes, hypertension, cerebrovascular disease, dementia, Alzheimer's disease, and systemic corticosteroid user were significant risk factors for mortality. A sensitivity test was accomplished to include only BP patients with dyslipidemia, and the results remained robust (data not shown).

Statins, with a presupposed role in the modulation of the inflammatory process, are well known for their protective role in a variety of inflammatory dermatoses.[4] Statins suppress not only antigen presentation but also activation of lymphocyte, that could have beneficial effects on BP, but further studies are needed to explore the possible mechanism. Statins might be considered to curtail the mortality rate of BP, as suggested by a previous study.[3] In conclusion, in this nationwide population-based cohort study with an appropriate comparison group, we failed to demonstrate the protective role of statins in the mortality of BP patients.

Financial support and sponsorship

This study was supported by the grant from the Ministry of Science and Technology, Taiwan, R.O.C. (MOST 108-2314-B-075-041-MY3).

Conflicts of interest

Prof. Yun-Ting Chang, an editorial board member at Dermatologica Sinica, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Supplementary Material

  References Top

Papadopoulou A, Zafiriou E, Koukoulis GK, Roussaki-Schulze AV. Drugs associated with bullous pemphigoid: Role of HMG-COa reductase inhibitors. J Eur Acad Dermatol Venereol 2020;34:e269-70.  Back to cited text no. 1
Bastuji-Garin S, Joly P, Lemordant P, Sparsa A, Bedane C, Delaporte E, et al. Risk factors for bullous pemphigoid in the elderly: A prospective case-control study. J Invest Dermatol 2011;131:637-43.  Back to cited text no. 2
Rozenblat M, Halaj A, Rozenblat T, Fisher S, Sah M, Dodiuk-Gad RP, et al. Mortality and risk factors among Israeli bullous pemphigoid patients. Arch Dermatol Res 2019;311:19-27.  Back to cited text no. 3
Jowkar F, Namazi MR. Statins in dermatology. Int J Dermatol 2010;49:1235-43.  Back to cited text no. 4


  [Table 1]


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