DPP4i use is linked to bullous pemphigoid

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Takeaway

  • Discontinuation of dipeptidyl peptidase-4 inhibitor (DPP4i) treatment in patients with type 2 diabetes (T2D) should be considered if bullous pemphigoid (BP) is diagnosed.

Why this matters

  • BP can be life-threatening, especially in older people.

Study design

  • Retrospective case-control study, 82 patients with T2D and BP compared with 328 with T2D and without BP, matched for age, sex, ethnicity.   
  • Funding: None disclosed.

Key results

  • DPP4is used by 44% with BP vs 21.6% without (P<.001 latency months.>
  • In median 2-year follow-up, OR for BP development with DPP4is was 2.83 (95% CI, 1.70-4.71).
  • Significant associations were seen with (ORs [95% CIs]): 
    • Vildagliptin (Galvus): 9.28 (4.54-18.99) and 
    • Linagliptin (Tradjenta): 6.61 (2.28-19.17),
    • But not sitagliptin (Januvia): 0.42 (0.17-1.01).
  • In multivariate analysis, independent associations with BP were seen for (aORs [95% CIs]):
    • Overall DPP4i use: 3.16 (1.86-5.37),
    • Vildagliptin: 10.67 (5.09-22.36), and
    • Linagliptin: 6.65 (2.24-19.72).
  • Among patients with BP, those with DPP4i exposure had more mucosal surface involvement (22.2% vs 6.5%; P=.04) but less peripheral eosinophilia (22.2% vs 55.6%; P=.002).
  • Partial/complete BP remission occurred in 18/19 in whom DPP4i treatment was stopped vs 3/13 who continued treatment.

Limitations

  • Retrospective data collection.
  • Small population.
  • Single-center study.
  • Propensity-score matching not performed because of database limitations.