Clinical characteristics and risk management of drug-induced lupus associated with stilbene amine antiepileptic drugs

doi:10.5246/jcps.2026.01.005

Abstract

Abstract:

This study aimed to elucidate the clinical features and temporal patterns of drug-induced lupus (DIL) associated with the stilbene amine antiepileptic drugs carbamazepine and oxcarbazepine. A comprehensive systematic review was conducted using multiple literature databases. Both domestic and international case reports of DIL linked to these agents were screened and analyzed. A total of 22 eligible cases were identified, comprising 19 cases related to carbamazepine and three to oxcarbazepine. Analysis revealed a mean patient age of 32.50 ± 16.08 years, with a marked female predominance (72.73%, 16/22). The latency period, the duration between drug initiation and the onset of DIL, was notably prolonged and variable, averaging 56.93 ± 75.57 months. Clinically, DIL presented as a multi-system disorder, with hematologic abnormalities (e.g., thrombocytopenia, anemia, and leukopenia) observed in 68.18% of cases, musculoskeletal symptoms (arthritis or joint pain) in 59.09%, and cutaneous involvement (rash or photosensitivity) in 54.55%. Following drug discontinuation and, in some instances, glucocorticoid therapy, clinical improvement was observed to varying degrees. Notably, 31.82% of patients experienced complete symptom resolution within 7 d. Given the insidious onset and multi-organ involvement of DIL, our findings underscored the importance of heightened clinical vigilance and routine monitoring protocols during antiepileptic drug therapy. This study highlighted the need for a dynamic risk-benefit assessment in the clinical use of antiepileptic drugs and provides valuable insights for the management of rare but serious neurological adverse reactions.

Key words: Antiepileptic drugs, Carbamazepine, Oxcarbazepine, Drug-induced lupus, Adverse drug reactions

Supporting:

Xinyu Chang, Zheng Fan, Yang Liu, Lijuan Han, Honglei Wang, Luyang Li, Wei Xiao. Clinical characteristics and risk management of drug-induced lupus associated with stilbene amine antiepileptic drugs[J]. Journal of Chinese Pharmaceutical Sciences, 2026, 35(1): 71-79.

Figures/Tables 4

Table 1. Distribution of gender and age in 22 cases.

Table 2. Distribution of the onset time of ADRs.

Table 3. Main manifestations and clinical treatment of ADRs caused by sodium valproate in lupus.

Table 4. ADRs of carbamazepine- and oxcarbazepine-induced lupus mainly involve organs systems and their clinical manifestations.

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