Risk of Parkinson disease in Sjögren syndrome administered ineffective immunosuppressant therapies: A nationwide population-based study

Medicine (Baltimore). 2019 Apr;98(14):e14984. doi: 10.1097/MD.0000000000014984.

Abstract

To determine the incidence and risk of Parkinson disease (PD) in patients with Sjögren syndrome (SS) according to a nationwide population-based database.In total, 12,640 patients in the SS cohort and 50,560 in the non-SS cohort were enrolled from Taiwan's National Health Insurance Research Database from 2000 to 2010. We used the Cox multivariable proportional hazards model to determine the risk factors for PD in the SS cohort.We observed an increased incidence of PD in patients with SS, with a crude hazard ratio (HR) of 1.40 and an adjusted HR (aHR) of 1.23. The cumulative incidence of PD was 1.95% higher in the SS cohort than in the non-SS cohort. The SS cohort had an elevated HR under medication use, namely cevimeline and pilocarpine (crude HR, 1.28), hydroxychloroquine (crude HR, 1.43; aHR, 1.46), and methylprednisolone (crude HR, 2.21; aHR, 1.49). Patients receiving other non-hydroxychloroquine immunosuppressant therapies had a lower risk (aHR, 0.86) of PD. Furthermore, patients with SS aged 20 to 49 years had a 1.93-fold higher risk of PD than did those without SS (aHR, 1.93). The risk of PD was higher (aHR, 2.20) in patients with SS without comorbidities than in those with comorbidities. The aHR of PD significantly increased when the follow-up period exceeded 9 years (aHR, 1.93).We determined an increased risk of PD in patients with SS. Further investigation is warranted to determine the possible underlying mechanisms and the potential role of non-hydroxychloroquine immunosuppressants in ameliorating PD.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use
  • Comorbidity
  • Female
  • Humans
  • Hydroxychloroquine / adverse effects
  • Hydroxychloroquine / therapeutic use
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppression Therapy / statistics & numerical data
  • Incidence
  • Male
  • Methylprednisolone / adverse effects
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Muscarinic Agonists / adverse effects
  • Muscarinic Agonists / therapeutic use
  • National Health Programs / statistics & numerical data
  • Parkinson Disease / epidemiology
  • Parkinson Disease / etiology*
  • Pilocarpine / adverse effects
  • Pilocarpine / therapeutic use
  • Quinuclidines / adverse effects
  • Quinuclidines / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Sjogren's Syndrome / complications
  • Sjogren's Syndrome / diagnosis
  • Sjogren's Syndrome / drug therapy*
  • Sjogren's Syndrome / epidemiology
  • Taiwan / epidemiology
  • Thiophenes / adverse effects
  • Thiophenes / therapeutic use

Substances

  • Anti-Inflammatory Agents
  • Antirheumatic Agents
  • Muscarinic Agonists
  • Quinuclidines
  • Thiophenes
  • Pilocarpine
  • Hydroxychloroquine
  • cevimeline
  • Methylprednisolone