Patients who initiated dipeptidyl peptidase-4 (DPP-4) inhibitor therapy for type 2 diabetes had an increased risk of bullous pemphigoid (BP) compared with patients who initiated second-generation sulfonylurea, according to a study published online in JAMA Dermatology. Although the adverse event was rare, it was higher in specific patient subgroups.
“Therefore, although clinicians should not avoid DPP-4 inhibitors entirely in patients with type 2 diabetes who may be otherwise good candidates for the therapy, they should be aware of the potential risk of BP in DPP-4 inhibitor use, especially in subgroups of older and white patients and linagliptin users,” the researchers said.
An autoimmune blistering disease characterized by tense blisters and urticarial plaques, BP has been reported with DPP-4 inhibitor use in case series, pharmacovigilance reports, and case-control studies. The researchers conducted their retrospective cohort study to compare the risk of BP with DPP-4 inhibitors and second-generation sulfonylureas, the most commonly prescribed second-line antidiabetic agents, using two US commercial insurance claims and Medicare databases.
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Among 1.6 million patients with type 2 diabetes, the incidence rate of BP per 1000 person-years was 0.42 in patients treated with DPP-4 inhibitors compared with 0.31 in patients treated with sulfonylurea, the study found. In addition, the risk of BP was 42% higher with DPP-4 inhibitors compared with sulfonylurea.
Subgroup analyses showed the risk of BP was highest in patients aged 65 years or older, white, and treated with linagliptin. The elevated risk occurred in both men and women.
“Our study shows that there is an increased risk of BP among DPP-4 inhibitor users compared with second-generation sulfonylurea users,” the researchers wrote. “However, DPP-4 inhibitor-associated BP is rare and may remit after discontinuing the culprit drug.”
Lee H, Chung HJ, Pawar A, Patorno E, Kim DH. Evaluation of risk of bullous pemphigoid with initiation of dipeptidyl peptidase-4 inhibitor vs second-generation sulfonylurea. JAMA Dermatol. Published online July 22, 2020. doi:10.1001/jamadermatol.2020.2158