Use of DPP-4 Inhibitors May Increase Risk of Developing Bullous Pemphigoid in Diabetic Patients

Dipeptidyl-Peptidase 4 Inhibitors (DPP-4), belong to a class of anti-hyperglycemic agents indicated for improving glycemic control in patients with type-2 diabetes. As their use has increased, so has the number of cases of Bullous Pemphigoid (BP), a chronic skin disorder characterized by blisters, hives and itching.

A recent study used a case-control method to answer the question of whether the use of DPP-4 inhibitors increased the risk for bullous pemphigoid (BP) in patients with diabetes, and to describe the clinical characteristics and outcomes of patients with DPP-4 inhibitor–associated BP. The study compared 82 patients with diabetes and BP and 328 control participants with diabetes but without BP.

The results showed that use of the DPP-4 inhibitors vildagliptin and linagliptin was associated with increased risk for BP. Patients with DPP-4 inhibitor–associated BP presented with more lesions on the mucosal surfaces and had lower peripheral eosinophil counts. In addition, the condition was more likely to affect men than women, especially those under 70 years of age. When patients discontinued treatment with DPP-4 inhibitors, clinical outcomes improved.

The authors conclude that this study confirms the association between BP and the use of DPP-4 inhibitors. Therefore, if a patient using these agents develops BP, discontinuation is recommended. The authors note that the increase in use of DPP-4 inhibitors may be an explanation for the increase in BP in the elderly population.