Dipeptidyl peptidase-IV inhibitors, a risk factor for bullous pemphigoid. Retrospective multicenter case-control study in France and Switzerland.

Benzaquen, Michael; Borradori, Luca; Berbis, Philippe; Cazzaniga, Simone; Valero, René; Richard, Marie-Aleth; Feldmeyer, Laurence (2018). Dipeptidyl peptidase-IV inhibitors, a risk factor for bullous pemphigoid. Retrospective multicenter case-control study in France and Switzerland. Journal of the American Academy of Dermatology, 78(6), pp. 1090-1096. Elsevier 10.1016/j.jaad.2017.12.038

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BACKGROUND

Case reports have suggested an association between dipeptidyl peptidase-IV inhibitors (DPP4i) and development of bullous pemphigoid (BP).

OBJECTIVE

To evaluate the association between DPP4i treatment and development of BP.

METHODS

We conducted a retrospective 1:2 case-control study, comparing diabetic BP cases to age and sex-matched diabetic controls, issued from Swiss (Bern) and French (Marseille) dermatological departments, from January 1st 2014 to July 31st 2016.

RESULTS

We collected 61 diabetic BP patients and 122 controls. DPP4i were associated with an increased risk of developing BP (adjusted OR=2.64; 95% CI: 1.19-5.85; p=0.02), with vildagliptin showing the highest adjusted OR (3.57; 95% CI: 1.07-11.84; p=0.04). Stratified analysis showed a stronger association in males and patients aged 80 years or older. DPP4i withdrawal and the institution of first-line treatments led to clinical remission in 95% of cases.

LIMITATIONS

This was a retrospective study in tertiary referral hospitals. We focused the analysis on DPP4i intake, without analyzing the potential isolated effect of metformin.

CONCLUSIONS

DPP4i, especially vildagliptin, are associated with an increased risk of developing BP. Their use needs to be carefully evaluated, particularly in high-risk patients, such as males and those aged 80 years or older.

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