Increased frequency of multiple sclerosis among bullous pemphigoid patients. A population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid

Abstract

Background

Bullous pemphigoid (BP) is a disease of the elderly, and may be associated to neurological, cardiovascular diseases and diabetes. Mortality rates strongly exceed that of the background population.

Objectives

We aimed to investigate the frequency of comorbidities and their temporal relation to BP.

Methods

A register-based matched cohort study on all Danish patients with a hospital-based diagnosis of BP (n = 3,281). Main outcomes were MS, Parkinson's disease (PD), Alzheimer's disease (AD), stroke (ST), diabetes (DM I and II), malignancies (MAL), ischaemic heart disease (IHD) and hypertension (HYP) and eventually death.

Results

At baseline, BP patients had an increased prevalence of MS, odds ratio (OR)_MS 9.7 (95% confidence interval (CI) 6.0-15.6), OR_PD 4.2 (95% CI 3.1-5.8), OR_AD 2.6 (95% CI 1.8-3.5) and OR_ST 2.7 (95% CI 2.4-2.9). Furthermore, MAL, cardiovascular disease and DM were overrepresented among BP patients, OR_DMI 3.1 (95% CI 2.5-3.8), OR_DMII 2.3 (95% CI 2.0-2.6), OR_MAL 1.3 (95% CI 1.1-1.4), OR_IHD 1.7 (95% CI 1.5-1.8) and OR_HYP 2.0 (95% CI 1.8-2.2). During follow-up, the risk of MS was significantly higher among BP patients, HR_MS 9.4 (95% CI 4.9-18.0), even if events during the first year after diagnosis of BP were excluded HR_MS-1 5.1 (95% CI 2.3-11.3). BP patients had an average increased mortality rate of 2.04 (95% CI 1.96-2.13).

Conclusions

We discovered a significantly increased frequency of MS among BP patients. At the time of diagnosis, BP patients had an excessive number of comorbidities and an increased mortality rate over the years to follow.

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