Findings of a cohort study suggest that dipeptidyl peptidase 4 (DPP-4) inhibitor use is associated with a higher risk of bullous pemphigoid (BP) compared with sulfonylurea. The results from Lee et al were published in JAMA Dermatology.
The study analyzed data from the Optum Clinformatics Data Mart (October 17, 2006 - December 31, 2018), IBM MarketScan Research Database (October 17, 2006 - December 31, 2017), and Medicare (January 1, 2006 - December 31, 2016) to characterize the incidence rate of BP among patients with type 2 diabetes who received DPP-4 inhibitors vs those treated with second-generation sulfonylureas. The rate along with hazard ratio (HR) and 95% CI were estimated, and subgroup analyses by age, sex, race, and individual DPP-4 agents were also performed. Results from each of the three insurance claim databases were pooled using an inverse-variance fixed-effects meta-analysis.
A total of 1,664,880 patients were included in the study. In the DPP-4 group, 51.0% of patients were female with a mean age of 63.0 ± 9.7 years, and in the sulfonylurea group, 50.4% were female with a mean age of 63.9 ± 9.9 years.
In the DPP-4 group, the incidence rate BP per 1000 person-years was 0.42 compared with 0.31 for the sulfonylurea group (HR, 1.42; 95% CI, 1.17-1.72). In patients who were 65 years or older, those on DPP-4 inhibitors had a BP Incidence rate of 0.79 per 1000 person-years vs only 0.49 in the sulfonylurea group. In addition, patients who were White (0.93 vs 0.54; HR, 1.70; 95% CI, 1.30-2.24) or were treated with lingliptin (1.20 vs 0.55; HR, 1.68; 95% CI, 1.16-2.43) had higher BP incidence rates than patients who were treated with sulfonylurea.
“Clinicians should be aware of this rare adverse effect of DPP-4 inhibitors,” said the research group, particularly in patients who are older or White or take linagliptin.
Reference
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
