Increased Risk of Bullous Pemphigoid after First-Ever Stroke: A Population-Based Study

Abstract

Background: We hypothesize that autoantibodies are induced after the blood-brain barrier is damaged by stroke and the risk of bullous pemphigoid (BP) is increased after stroke. We assess the risk of BP after first-ever stroke in a nationwide population-based cohort of first-ever stroke patients. Methods: We extracted data from the Longitudinal Health Insurance Database 2005 and identified patients with first-ever stroke as well as control patients matched for age, gender, and year of enrollment. The risk of BP in first-ever stroke patients in comparison with that in control patients was analyzed using Cox regression. Results: Of 12,607 patients with first-ever stroke, 38 (0.3%) patients developed BP in a median of 3.5 years. In the control patients, 8 persons (0.06%) had BP in a median of 3.7 years. The crude hazard ratio (HR) of BP in first-ever stroke patients was 4.83 (95% CI 2.25-10.34, p < 0.001) compared to the control group. The adjusted HR was 4.20 (95% CI 1.94-9.08, p < 0.001) after adjustments for age, gender, hypertension, diabetes, dementia, epilepsy, Parkinson disease, furosemide, and neuroleptics for stroke patients. Conclusions: The risk of BP is increased in first-ever stroke patients in a nationwide population-based cohort and this association is independent of well-known confounders of BP.

Comorbidities and Treatment Strategies in Bullous Pemphigoid: An Appraisal of the Existing Litterature

“…Other prednisolone sparing immune modulating agents include Cyclosporine, Rituximab ( 28 , 30 , 31 ), intravenous immunoglobulin ( 32 ), Cyclophosphamide ( 33 ), and plasmapheresis ( 34 , 35 ). Some of these treatments can be used in combination ( 36 ).…”

Anti-BP180 Autoantibodies Are Present in Stroke and Recognize Human Cutaneous BP180 and BP180-NC16A

“…It is characterized by an acute onset and considerably severe tissue damage in the brain. Recently, a study including 12,607 patients with first-ever stroke has revealed that 38 (0.3%) patients developed BP in a median of 3.5 years, while only eight people (0.06%) had BP in a median of 3.7 years in the control group (10). In addition, a population-based case-control study has shown that there was a 2-fold increase in risk of developing BP in those with acute ischemic stroke in the UK (11).…”

Bullous pemphigoid and diabetes mellitus: a systematic review and meta‐analysis

“…A total of 17 studies were analyzed in this systematic review, 2–18 with the majority being case–control studies that used age and sex matching. The studies encompassed diverse populations, with 11 from Europe and six from Asia.…”