Dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid showing positive autoantibody responses to multiple epitopes

2021 ◽  
Author(s):  
Rikuma Kitao ◽  
Takeshi Fukumoto ◽  
Takashi Hashimoto ◽  
Kentaro Izumi ◽  
Haruki Jimbo ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor

scholarly journals Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

2021 ◽  
Vol 10 (9) ◽  
pp. 1916
Author(s):  
Ágnes Kinyó ◽  
Anita Hanyecz ◽  
Zsuzsanna Lengyel ◽  
Dalma Várszegi ◽  
Péter Oláh ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Clinical Laboratory ◽  
Case Series ◽  
Dipeptidyl Peptidase ◽  
Area Index ◽  
Histological Features ◽  
Dipeptidyl Peptidase 4 ◽  
First Case ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
The Mean

Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, p < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, p = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.

Dipeptidyl peptidase‐4 inhibitor‐related bullous pemphigoid: A comparative study of 100 patients with bullous pemphigoid and diabetes mellitus

2021 ◽  
Vol 48 (4) ◽  
pp. 486-496 ◽  
Author(s):  
Kumutnart Chanprapaph ◽  
Nathathai Pratumchart ◽  
Preeyachat Limtong ◽  
Suthinee Rutnin ◽  
Chonlaphat Sukasem ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Comparative Study ◽  
Bullous Pemphigoid ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor

scholarly journals Exacerbation of well‐controlled bullous pemphigoid by the administration of a dipeptidyl peptidase‐4 inhibitor

2019 ◽  
Vol 44 (7) ◽  
pp. 830-832 ◽  
Author(s):  
C. Nishiyama ◽  
C. Tateishi ◽  
T. Hashimoto ◽  
M. Nishida ◽  
A. Imanishi ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor

scholarly journals Clinical Features and Outcomes of Dipeptidyl Peptidase-4 Inhibitor-Associated Bullous Pemphigoid (DPP4i-Associated BP) in Thai Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yotsapon Thewjitcharoen ◽  
Ekgaluck Wanothayaroj ◽  
Chattip Thammawiwat ◽  
Sriurai Porramatikul ◽  
Chuleekorn Vorayingyong ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Case Series ◽  
Latency Period ◽  
Dipeptidyl Peptidase ◽  
Elderly Male ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Potential Link ◽  
Male Patients

The use of dipeptidyl peptidase-4 inhibitors (DPP4i) appears to be associated with a small but significantly elevated risk of bullous pemphigoid (BP). Although the pathogenic mechanism of DPP4i-associated BP remains unclear, this adverse event is reported with multiple gliptins, suggesting a class effect. However, previous studies from various countries showed that vildagliptin had been implicated in most cases. The aim of this study was to illustrate a case series of DPP4i-associated BP in Thai patients. We conducted a retrospective study from consecutive cases of BP in people with type 2 diabetes mellitus (T2DM) from January 2008, the year in which the first DPP4i was introduced in Thailand, until December 2019. During the study period, 10 BP patients with T2DM were identified. A total of 5 DPP4i-associated BP (3 on vildagliptin, 1 on linagliptin, and 1 on sitagliptin) were found. All patients were male with a mean age at BP development of 80.4 years (73–86 years). All patients had a long-standing duration of diabetes (median duration 34 years), and mean A1C was 7.5 ± 1.4%. The median time to BP development after the introduction of DPP4i was 64 months (range 20–128 months). The severity of BP was classified as mild in 2 cases. In all cases, the association between the drug intake and BP onset was classified as “possible” according to the Naranjo causality scale. All of the patients continued taking DPP4i after BP diagnosis, and one patient died of lung cancer 18 months after BP diagnosis. Only 2 patients could achieve complete remission at least 2 months after stopping DPP4i. Our case series demonstrated a potential link between DPP4i and the development of BP, which mainly occurred in very elderly male patients. The latency period from an introduction of DPP-4i could be several years, and the clinical course after DPP4i discontinuation varied. Clinicians prescribing DPP4i should be aware of this association and consider stopping this medication before a refractory disease course ensues.

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