Vildagliptin and linagliptin use associated with bullous pemphigoid
Japan:A recent study in The Journal of Dermatology showed that dipeptidyl peptidase-4 inhibitors (DPP-4i) have been linked to cases of rare skin condition, bullous pemphigoid, prompting authors to suggests trying DPP-4i discontinuation followed by supportive care. Vildagliptin and linagliptin were found to be the most common DPP-4i associated with bullous pemphigoid (BP).
The authors wrote, "non-inflammatory and mild cases of DPP-4i associated bullous pemphigoid may resolve spontaneously with supportive care, including DPP-4i discontinuation and no oral corticosteroid therapy."
In patients taking dipeptidyl peptidase-4 inhibitors, many cases of BP have been reported. DPP-4i are the most widely used antidiabetic drug for type 2 diabetes mellitus. However, in Japan, no large-scale survey has been conducted. Therefore, Seiko Sugiyama, Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan, and colleagues aimed to investigated the incidence, clinical presentation, and clinical course of DPP-4i-associated BP (DPP-4i-BP) using epidemiological data from a nationwide registry for BP in a retrospective study.
For this purpose 713 new BP patients at 94 dermatological institutes were registered in 2016, 243 (34.1%) with DPP-4i-BP and 461 (64.7%) with non-DPP-4i-BP. The male-to-female ratio respectively was 1.9 and 0.84. Patients with DPP-4i-BP were predominantly male.
Based on the study, the researchers found the following:
- Non-inflammatory BP was more common in DPP-4i-BP (33.3%) than in non-DPP-4i-BP (14.6%), while inflammatory BP was common in both.
- No specific subtype or difference in disease severity was evident in DPP-4i-BP.
- The most common gliptins administered to DPP-4i-BP patients were vildagliptin (37.2%) and linagliptin (23.8%). DPP-4i intake was discontinued in 79.9% of cases after diagnosis.
- Some DPP-4i-BP patients (17.6%) achieved spontaneous remission after discontinuing DPP-4i without requiring the use of systemic corticosteroids and/or adjuvant therapy.
- Mean duration to achieve disease control was 2.87 months.
- The odds ratio for non-inflammatory BP requiring systemic corticosteroids and/or adjuvant therapy was low (0.52), suggesting that remission was achieved easily with supportive care in that phenotype.
The researchers conclude, "non-inflammatory and mild cases of DPP-4i-BP may resolve spontaneously with supportive care, including the discontinuation of DPP-4i and no oral corticosteroid therapy."
Reference:
Sugiyama S, Yamamoto T, Aoyama Y. Clinical features of dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in Japan: A nationwide retrospective observational study. J Dermatol. 2022 Jul;49(7):697-702. doi: 10.1111/1346-8138.16394. Epub 2022 Apr 27. PMID: 35478414.
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.