DPP4 Inhibitors Confer Increased Odds of Bullous Pemphigoid Even Years After Drug Initiation in Patients With Diabetes

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• The authors of this population-based nested case–control study found that patients with diabetes exposed to DPP4 inhibitors had an 80% increased odds of developing bullous pemphigoid (BP) compared with those not exposed. BP was most likely to develop 1 to 2 years after drug initiation, but DPP4 inhibitor use was associated with BP development even after 6 or more years following drug initiation. Patients with diabetes exposed to DPP4 inhibitors who developed BP were more likely to be hospitalized and had more outpatient dermatologist visits than those with BP who were not exposed.
• These findings indicate that patients with diabetes exposed to DPP4 inhibitors are at an increased risk of developing BP and that BP commonly occurs years after drug initiation.

–  Kelly B. Scarberry, MD

Abstract

The timing pattern in which dipeptidyl-peptidase IV inhibitors (DPP4i) confer the risk of bullous pemphigoid (BP) is unknown. To investigate the odds of BP following exposure to DPP4i and to perform a duration-response analysis evaluating the risk of BP in relation to the duration of exposure to the culprit drug. A population-based nested case-control study was performed comparing diabetic patients with BP (n = 1458) with age-, sex- and ethnicity-matched diabetic control subjects (n = 6051) with respect to the prevalence of exposure to DPP4i. Adjusted odds ratios (ORs) were estimated by logistic regression. Overall exposure to DPP4i was associated with an 80% increase in the odds of subsequent BP (OR, 1.81; 95% CI, 1.46-2.08; P < 0.001). In an intraclass analysis, the odds of BP were increased in association with vildagliptin (OR, 3.40; 95% CI, 2.69-4.29; P < 0.001) and sitagliptin (OR, 1.56; 95% CI, 1.33-1.84; P < 0.001). In a duration-response analysis, the highest likelihood of BP was found 1-2 years after commencing the drug (OR, 2.66; 95% CI, 1.97-3.59; P < 0.001). The odds of BP were increased across all time periods and retained its statistical significance even ≥ 6 years after the drug initiation (OR, 1.44; 95% CI, 1.09-1.91; P = 0.011). Relative to other diabetic patients with BP, patients with DPP4i-associated BP were more likely to be admitted to inpatient dermatologic wards (OR, 1.66; 95% CI, 1.30-2.13; P < 0.001) and had higher mean(SD) numbers of outpatient dermatologist visits (14.7[14.8] vs. 12.3[13.2], respectively; P = 0.006). DPP4i should be suspected as a predisposing factor for BP even numerous years after the drug initiation.

Archives of Dermatological Research

Dipeptidyl-peptidase IV inhibitor (DPP4i) confers increased odds of bullous pemphigoid even years after drug initiation

Arch Dermatol Res 2023 Jan 01;315(1)33-39, K Kridin, O Avni, G Damiani, D Tzur Bitan, E Onn, O Weinstein, AD Cohen 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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