Confirmation of PPI and lupus link 

3 minute read

But the good news is that stopping the medication leads to remission in most patients.

Stopping PPIs was enough to clear up drug-induced lupus erythematosus in half of patients who had the condition, researchers have found. 

While the findings shouldn’t scare doctors or patients off PPIs, the link was worth investigating in patients who develop lupus, said Melbourne dermatologist Professor Rod Sinclair.  

“Sometimes just stopping that drug will lead to resolution,” he said. 

This study confirmed” the link between PPIs and drug-induced systemic lupus erythematosus (DI-SLE) and drug-induced cutaneous lupus erythematosus (DI-CLE), the authors wrote in a research letter in JAMA Dermatology

Their analysis of two large international databases found that half of the patients who stopped taking the medication went into remission, and another one in four recovered with additional treatment.  

This was the first report on the therapeutic management of PPI-associated drug-induced lupus cases, the authors said.  

One database of more than 21 million lupus cases over the last three decades found 625 cases were drug-induced and associated with a PPI. In half of these cases, a PPI was the only suspected drug, and omeprazole was the most common one – accounting for one third of cases.  

Another database included more than 790,000 lupus cases over a similar time period. Of these, 60 were drug-induced lupus associated with a PPI.  

Esomeprazole was the most frequently involved PPI, accounting for half the cases. Researchers were able to identify a sole drug responsible in four out of five patients, and around half of these participants had subacute DI-CLE. 

The researchers also identified discoid DI-CLE in two patients, tumidus DI-CLE in one patient and unspecified DI-CLE in 17 patients.  

Seven of these patients had cutaneous involvement.  

Around two in three patients stopped taking their PPIs over the course of the study, and half of these went into remission without any specific treatment. Another quarter of these patients recovered with treatment. Outcomes for the remaining nine patients was not available. 

Patients were typically in their 60s and around two in three were women.  

Professor Sinclair, who was not associated with the study, said the finding should not cause alarm, but dermatologists should be aware of the link. 

“This is just another class of medication to add to the long list of drugs already known to cause chronic cutaneous lupus,” he said.  

“I don’t think this is going to stop anybody using them [PPIs],” he told Dermatology Republic.  

“But it’s good to alert dermatologists that this is just another class of drugs that have been associated with drug induced chronic cutaneous lupus.” 

Professor Sinclair said it was useful for dermatologists to ask patients with lupus whether they were taking PPIs. 

“It’s worth asking the question and try taking them off it and see whether that resolves the condition,” he said. 

JAMA Dermatology 2022, online 17 August 

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