University of Oulu

Dikmen, H.O., Yilmaz, K., Benoit, S., Bernard, P., Drenovska, K., Gerdes, S., Gläser, R., Günther, C., Homey, B., Horváth, O.N., Huilaja, L., Joly, P., Kiritsi, D., Meller, S., Patsatsi, A., Sárdy, M., Schauer, F., Shahid, M., Sticherling, M., Tasanen, K., Vassileva, S., Worm, M., Zillikens, D., Sadik, C.D., van Beek, N., König, I.R. and Schmidt, E. (2022), Serum autoantibody reactivity in bullous pemphigoid is associated with neuropsychiatric disorders and the use of antidiabetics and antipsychotics: a large, prospective cohort study. J Eur Acad Dermatol Venereol, 36: 2181-2189.

Serum autoantibody reactivity in bullous pemphigoid is associated with neuropsychiatric disorders and the use of antidiabetics and antipsychotics : a large, prospective cohort study

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Author: Dikmen, H. O.1; Yilmaz, K.1; Benoit, S.2;
Organizations: 1Department of Dermatology, University of Lübeck, Lübeck, Germany
2Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
3Department of Dermatology, University of Reims, Reims, France
4Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
5Department of Dermatology, Venerology and Allergology, University of Kiel, Kiel, Germany
6Department of Dermatology, University of Dresden, Dresden, Germany
7Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
8Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
9PEDEGO Research Unit, Department of Dermatology, Medical Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
10Department of Dermatology, University of Rouen, Rouen, France
11Department of Dermatology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
122nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
13Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
14Department of Dermatology, University of Erlangen, Erlangen, Germany
15Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
16Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
17Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-06-29


Background: Bullous pemphigoid (BP), the by far most frequent autoimmune blistering skin disease (AIBD), is immunopathologically characterized by autoantibodies against the two hemidesmosomal proteins BP180 (collagen type XVII) and BP230 (BPAG1 or dystonin). Several comorbidities and potentially disease-inducing medication have been described in BP, yet a systematic analysis of these clinically relevant findings and autoantibody reactivities has not been performed.

Objective: To determine associations of autoantibody reactivities with comorbidities and concomitant medication.

Methods: In this prospective multicenter study, 499 patients diagnosed with BP in 16 European referral centers were included. The relation between anti-BP180 NC16A and anti-BP230 IgG ELISA values at the time of diagnosis as well as comorbidities and concomitant medication collected by a standardized form were analysed.

Results: An association between higher serum anti-BP180 reactivity and neuropsychiatric but not atopic and metabolic disorders was observed as well as with the use of insulin or antipsychotics but not with dipeptidyl peptidase-4 (DPP4) inhibitors, inhibitors of platelet aggregation and L-thyroxine. The use of DPP4 inhibitors was associated with less anti-BP180 and anti-BP230 reactivity compared with BP patients without these drugs. This finding was even more pronounced when compared with diabetic BP patients without DPP4 inhibitors. Associations between anti-BP180 and anti-BP230 reactivities were also found in patients using insulin and antipsychotics, respectively, compared with patients without this medication, but not for the use of inhibitors of platelet aggregation, and L-thyroxine.

Conclusion: Taken together, these data imply a relation between autoantibody reactivities at the time of diagnosis and both neuropsychiatric comorbidities as well as distinct concomitant medication suggesting a link between the pathological immune mechanisms and clinical conditions that precede the clinically overt AIBD.

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Series: Journal of the European Academy of Dermatology and Venereology
ISSN: 0926-9959
ISSN-E: 1468-3083
ISSN-L: 0926-9959
Volume: 36
Issue: 11
Pages: 2181 - 2189
DOI: 10.1111/jdv.18414
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work received infrastructural and financial support from the DFG-funded research consortium Clinical Research Unit 303 Pemphigoid Diseases, Collaborative Research Center CRC 1526 Pathomechanisms of Antibody-mediated Autoimmunity (PANTAU) and the Schleswig-Holstein Excellence Cluster Precision Medicine in Chronic Inflammation (DFG EXC 2167/1).
Copyright information: © 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.