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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.
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751