A case-control study revealed that combinations of drugs for cardiovascular diseases and hypertension were frequently prescribed before a diagnosis of bullous pemphigoid (BP), but the risk associated with combinations did not exceed that associated with individual agents. The most common drug combinations included angiotensin-converting enzyme (ACE) inhibitors with statins and antiplatelets with statins.
"The ARM algorithm exploratory analysis identified the most commonly prescribed drug combinations prior to BP. Logistic regression confirmed drug combinations for CVDs [cardiovascular diseases] or hypertension associated with increased BP risk," the authors wrote. "The increased BP risk following reported combinations was modest and was not greater than their constituent drugs. Given that the number of patients with BP is low, we do not suggest avoiding the reported drugs but instead being on the lookout for any skin reactions following treatments for CVDs or hypertension," they concluded.
This study was led by Mikolaj Swiderski, University of Nottingham, Nottingham, England. It was published online on August 06, 2025, in Clinical and Experimental Dermatology.
The ARM algorithm considered only the frequency of prescriptions to obtain drug combinations. Additionally, the algorithm demonstrated limited clinical value, linking only half of the inferred drug class combinations with BP and failing to capture the sequence or precise timing of prescriptions. It also lacked dosage and treatment duration data, and as an exploratory tool, ARM could not establish causal relationships between drug exposures and the risk for BP.
This research was supported by the National Institute for Health and Care Research grant via the Research for Patient Benefit Programme. Swiderski reported receiving salary funding from this grant. Another author reported receiving salary funding from King's College London, University of Nottingham, and the National Institute for Health and Care Research East Midlands scholarship scheme. Additional disclosures are noted in the original article.