Bullous Pemphigoid Associated with Dipeptidyl Peptidase 4 Inhibitors for the Treatment of Type 2 Diabetes: A Multicenter Study in Istanbul

Ece Ugurer; Ezgi Ozkur; Ilknur Kivanc Altunay; Esra Cil Sen; Ayse Esra Koku Aksu; Ilknur Ozcan; Yuksel Altuntas; Mehmet Salih Gurel

doi:10.14744/SEMB.2022.30111

Bullous Pemphigoid Associated with Dipeptidyl Peptidase 4 Inhibitors for the Treatment of Type 2 Diabetes: A Multicenter Study in Istanbul

Sisli Etfal Hastan Tip Bul. 2022 Sep 22;56(3):375-380. doi: 10.14744/SEMB.2022.30111. eCollection 2022.

Authors

Ece Ugurer¹, Ezgi Ozkur², Ilknur Kivanc Altunay², Esra Cil Sen³, Ayse Esra Koku Aksu⁴, Ilknur Ozcan⁵, Yuksel Altuntas³, Mehmet Salih Gurel⁵

Affiliations

¹ Deparment of Dermatology, Luleburgaz State Hospital, Kırklareli, Türkiye.
² Department of Dermatology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
³ Department of Endocrinology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
⁴ Department of Dermatology, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul, Türkiye.
⁵ Department of Dermatology, Istanbul Medeniyet University Faculty of Medicine, Prof. Dr. Süleyman Yalcin City Hospital, Istanbul, Türkiye.

Abstract

Objectives: Recent studies have revealed an association between dipeptidyl peptidase 4 inhibitors (DPP4i) and development of bullous pemphigoid (BP). The main aim of our study is to evaluate the association between DPP4i treatment and BP development. The secondary endpoints were to evaluate clinical characteristics and biochemical parameters of the DPP4i associated BP cases and determine the differences of DPP4i associated BP disease than non-DPP4i associated BP cases.

Methods: We designed a retrospective case-control study, comparing type 2 diabetic 58 BP cases to 75 type 2 diabetic controls. Data were collected from three dermatological departments in Istanbul/Turkey, from November 1, 2008, to January 1, 2019. Medical records of each patient's demographic, clinical characteristics, drugs used, and laboratory data were reviewed.

Results: There was no statistical difference in age and gender between the patient and control group. The most common prescribed oral antidiabetic for both groups was metformin. The most commonly prescribed DPP4i was vildagliptin. Fourteen (24.1%) out of 58 diabetic patients with BP were using vildagliptin, 12 (20.7%) out of 58 diabetic BP patients were using linagliptin, 6 (10.3%) out of 58 diabetic BP patients were using sitagliptin, and 1 (1.7%) out of 58 diabetic BP patients were using saxagliptin. There was no significant difference between the two groups regarding the DPP4 is use (using DPPi at the time of diagnosis and not). Both groups had similar clinical characteristics, localizations, disease severity, comorbidities, treatment responses, and biochemical parameters. BP patients using DPP4i had statistically less mucosal involvement than BP patients not using DPP4i (p=0.044).

Conclusion: Even though there was no difference between two groups, when BP develops in diabetic patients, DPP4 is should be questioned and with cooperation with clinician's consideration of change may be planned.

Keywords: Bullous pemphigoid; diabetes; dipeptidyl peptidase 4 inhibitors.