Vildagliptin and linagliptin use associated with bullous pemphigoid

Published On 2022-08-12 04:45 GMT   |   Update On 2022-08-12 10:14 GMT

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...

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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.

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Article Source : The Journal of Dermatology

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