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More Evidence Links DPP-4 Inhibitors With Bullous Pemphigoid

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Dipeptidyl peptidase 4 (DPP-4) inhibitors are associated with an increased risk of developing bullous pemphigoid (BP), according to the findings of a recent study.

In the retrospective study, the researchers identified 670 patients diagnosed with diabetes and BP and 670 patients with only diabetes, matched based on age, sex, and year of diabetes diagnosis, using Korean insurance claims data from January 1, 2012 to December 31, 2016. They calculated the number of patients with newly diagnosed BP and diabetes per year and annual changes in the proportion of patients with diabetes among those with BP, as well as determined the association between DDP-4 inhibitor use and risk of developing BP.

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From 2012 to 2016, the number of patients with diabetes and BP more than doubled from 77 to 206. Likewise, the proportion of patients with diabetes among all patients with BP increased from 0.18 in 2012 to 0.33 in 2016, the researcher wrote.

The researchers found that the use of DDP-4 inhibitors was significantly associated with an increased risk of developing BP (adjusted odds ratio [aOR], 1.58; 95% CI, 1.25-2.0), with highest risk associated with vildagliptin use (aOR 1.81; 95% CI, 1.31-2.5) (not approved by the FDA).

In addition, findings from subgroups analyses showed a significant association among male patients (aOR, 1.91; 95% CI, 1.39-2.63) and that the DPP-4 inhibitor with the highest risk was vildagliptin (aOR, 2.70; 95% CI, 1.73-4.34).

“Practitioners should consider that DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of BP in patients with diabetes,” the researchers concluded. “These nationwide, population-based results may serve as a foundation for further studies seeking to understand how DPP-4 inhibitors contribute to the development of BP.”


Lee SG, Lee HJ, Yoon MS, Kim DH. Association of dipeptidyl peptidase 4 inhibitor use with risk of bullous pemphigoid in patients with diabetes [published online January 9, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.4556

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