Michael Benzaquen1, Luca Borradori2, Philippe Berbis3, Simone Cazzaniga4, René Valero5, Marie-Aleth Richard6, Laurence Feldmeyer2. 1. Department of Dermatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. Electronic address: michael.benzaquen@ap-hm.fr. 2. Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Department of Dermatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 4. Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centro Studi GISED, Bergamo, Italy. 5. Department of Nutrition, Metabolic Diseases, Endocrinology, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, INSERM 1062, INRA 1260, NORT, Marseille, France. 6. Department of Dermatology, Hôpital La Timone, Assistance Publique-Hôpitaux de Marseille, UMR 911, INSERM CRO2, Centre de recherche en oncologie biologique et oncopharmacologie, Aix-Marseille University, member of the French Bullous Group from the French Society of Dermatology, Marseille, France.
Abstract
BACKGROUND: Case reports have suggested an association between dipeptidyl peptidase-4 inhibitors (DPP4is) 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 case patients with diabetes and BP with age- and sex-matched control patients with diabetes issued from Swiss (Bern) and French (Marseille) dermatologic departments from January 1, 2014, to July 31, 2016. RESULTS: We collected 61 case patients with diabetes and BP and 122 controls. DPP4is were associated with an increased risk for development of BP (adjusted odds ratio, 2.64; 95% confidence interval, 1.19-5.85; P = .02), with vildagliptin showing the highest adjusted odds ratio (3.57 [95% confidence interval, 1.07-11.84; P = .04]). Stratified analysis showed a stronger association in males and patients age 80 years or older. DPP4i withdrawal and the initiation 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: DPP4is, especially vildagliptin, are associated with an increased risk for development of BP. Their use needs to be carefully evaluated, particularly in high-risk patients, such as males and those age 80 years or older.
BACKGROUND: Case reports have suggested an association between dipeptidyl peptidase-4 inhibitors (DPP4is) 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 case patients with diabetes and BP with age- and sex-matched control patients with diabetes issued from Swiss (Bern) and French (Marseille) dermatologic departments from January 1, 2014, to July 31, 2016. RESULTS: We collected 61 case patients with diabetes and BP and 122 controls. DPP4is were associated with an increased risk for development of BP (adjusted odds ratio, 2.64; 95% confidence interval, 1.19-5.85; P = .02), with vildagliptin showing the highest adjusted odds ratio (3.57 [95% confidence interval, 1.07-11.84; P = .04]). Stratified analysis showed a stronger association in males and patients age 80 years or older. DPP4i withdrawal and the initiation 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: DPP4is, especially vildagliptin, are associated with an increased risk for development of BP. Their use needs to be carefully evaluated, particularly in high-risk patients, such as males and those age 80 years or older.