DPP-4 Inhibitors increase risk of development of Bullous Pemphigoid

As per research published in JAMA Dermatology, DPP-4 inhibitors were found to be associated with a significantly increased risk of the development of bullous pemphigoid (BP) in patients with diabetes.

Bullous pemphigoid (BP) is the chronic blistering of the skin. It ranges from mildly itchy welts to severe blisters and infection and may affect a small area of the body or be widespread.

Seon Gu Lee and his associates conducted a population-based, case-control study of insurance claims data from 1340 patients in Korea to characterize the potential association between the use of DPP-4 inhibitors and an increased risk of developing BP. The insurance claim data from January 1, 2012, to December 31, 2016, included patients with newly diagnosed BP and diabetes. Half the patients had BP, and the other half were age- and sex-matched controls with diabetes but not BP.

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The number of patients with newly diagnosed BP and diabetes per year and annual changes in the proportion of patients with diabetes among all patients with BP were measured.

“It is not clear why the use of DPP-4 inhibitors was associated with an increased risk of developing BP in only male patients," write the authors. "The exact pathogenesis of how DPP-4 inhibitors might cause BP remains unclear. DPP-4 inhibitors may alter the antigenic properties of the epidermal basement membrane and lead to modifications of the immune response in genetically predisposed patients," they added.

The key analysis of the study included are:

• The number of patients with diabetes and BP more than doubled during the study period.


• The proportion of patients with diabetes among all patients with BP also increased.


• The use of DPP-4 inhibitors was associated with a significant increase in the risk of developing BP.


• Subgroup analyses revealed a significant association in male patients and that vildagliptin was the most high-risk DPP-4 inhibitor.

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According to the researchers, of the DPP-4 inhibitors available in Korea, vildagliptin was associated with the highest risk, particularly in male patients.

The researchers suggested that clinicians should consider that DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of BP in patients with diabetes.

For full information log on to 10.1001/jamadermatol.2018.4556