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Association between Bovine Collagen Dermal Implants and a Dermatomyositis or a Polymyositis-like Syndrome

Jean Cukier, MD; Richard A. Beauchamp, MD; Joseph S. Spindler, MD; Sarah Spindler, MS; Carlos Lorenzo, MD; and David E. Trentham, MD
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From Baylor College of Medicine, Houston, Texas; Texas Department of Health, Austin, Texas; the Arthritis Clinic of Houston, Houston, Texas; Beth Israel Hospital and Harvard Medical School, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Boston, Massachusetts. Requests for Reprints: Jean Cukier, MD, 7000 Fannin, Suite 1470, Houston, TX 77030. Acknowledgments: The authors thank Mary Hosten-Hall for manuscript preparation, and Drs. Catherine McCuaig, Stephen Smiles, Stuart Rosenthal, and John Conte for assistance. They also thank Drs. Douglas J. Morrice and Merwin W. Hemphill Center for Statistical Sciences, University of Texas at Austin, for assistance with the Monte Carlo analysis.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(12):920-928. doi:10.7326/0003-4819-118-12-199306150-00002
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Objective: To determine whether an excess incidence of dermatomyositis or polymyositis or both exist in patients treated with injectable bovine collagen implants and to characterize the clinical picture.

Design: Historical cohort study (July 1980 through June 1988).

Patients: Patients were identified from personal experience or adverse reaction reports received by the manufacturer.

Setting: An 8-year period in the United States during which approximately 345 000 patients received implants.

Results: Eight patients with dermatomyositis and an additional patient with polymyositis were identified from approximately 345 000 patients receiving injectable bovine collagen implants from July 1980 through June 1988. The nine patients with dermatomyositis or polymyositis were diagnosed an average of 6.4 months (range, 0.7 to 24.9 months) after collagen implant or skin test exposure or both. Eight of the nine patients had a delayed-type hypersensitivity response at the test or treatment sites or both, and five of six patients tested were found to have increased serum antibodies to collagen. Compared with the general population, the incidence of dermatomyositis or polymyositis among collagen-treated patients was statistically increased (standardized incidence ratio, 5.05; 95% CI, 2.31 to 9.59; P < 0.0001). A similar analysis of the eight dermatomyositis case patients produced a standardized incidence ratio of 18.8 (CI, 8.1 to 37.0; P < 0.0001).

Using a Monte Carlo simulation, an interval of 6.4 months or less from exposure to onset of disease was found to be an extremely rare event, occurring less than 72 times per one million simulation trials (CI, 57 to 91).

Conclusions: Because these data suggest that an immunologic response to bovine type I or type III collagen or both caused this dermatomyositis or polymyositis-like syndrome, the risks versus benefits for the cosmetic use of collagen implants should be reassessed.


Grahic Jump Location
Figure 1.
Observed versus expected patients with dermatomyositis or polymyositis or both.

Patients were diagnosed within 6-month intervals after collagen exposure from July 1980 through June 1988. DM/PM = dermatomyositis or polymyositis or both.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Observed versus expected patients with dermatomyositis.

Patients were diagnosed within 6-month intervals after collagen exposure from July 1980 through June 1988. DM = dermatomyositis.

Grahic Jump Location




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