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Bullous Pemphigoid Associated With Several Medications

The development of bullous pemphigoid (BP) may be associated with the use of aldosterone antagonists, dipeptidyl peptidase 4 inhibitors, anticholinergics, and dopaminergic medications, according to the findings of a recent systematic review and meta-analysis.

In their systematic review, the researchers identified case-control or cohort studies, as well as randomized clinical trials, that had examined the odds or risk of BP associated with previous medication use. A total of 13 case-control studies, one cohort study, and one randomized clinical trial were included in the meta-analysis (N=285,884).
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The researchers followed the Meta-analysis of Observational Studies in Epidemiology guideline, using the Newcastle-Ottawa Scale to evaluate the risk of bias in observational studies and Cochrane Collaboration’s tool for the randomized clinical trial. They used random-effects model meta-analysis for aggregate data in studies that were sufficiently homogenous and performed subgroup analyses for use of various medications of the same category. In addition, the researchers calculated odds ratio (OR), hazard ratio (HR), and the risk ratio of BP in association with medication use.

In their meta-analysis of case-control studies, the researchers observed a significant association between BP and previous use of aldosterone antagonists (pooled OR, 1.75; 95% CI, 1.28-2.40), dipeptidyl peptidase 4 inhibitors (pooled OR, 1.92; 95% CI, 1.55-2.38), anticholinergics (pooled OR, 3.12; 95% CI, 1.54-6.33), and dopaminergic medications (pooled OR, 2.03; 95% CI, 1.34-3.05). In addition, the cohort study showed an increased risk of BP among patients being treated with dipeptidyl peptidase 4 inhibitors (HR, 2.38; 95% CI, 1.16-4.88; P =.02). The randomized clinical trial also found a higher occurrence of BP among patients with diabetes who were treated with linagliptin compared with the placebo group (0.2% vs 0%).

 “These medications should be judiciously prescribed, particularly in high-risk patients who are elderly and have disabling neurologic disorders,” the researchers concluded.


Liu S, Chen W, Chi C. Association between medication use and bullous pemphigoid: a systematic review and meta-analysis. JAMA Dermatol. Published online June 17, 2020. doi:10.1001/jamadermatol.2020.1587

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