Department of Dermatology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
J Am Acad Dermatol. 2018 Jun;78(6):1090-1096. doi: 10.1016/j.jaad.2017.12.038. Epub 2017 Dec 21.
Case reports have suggested an association between dipeptidyl peptidase-4 inhibitors (DPP4is) and development of bullous pemphigoid (BP).
To evaluate the association between DPP4i treatment and development of BP.
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.
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.
This was a retrospective study in tertiary referral hospitals. We focused the analysis on DPP4i intake, without analyzing the potential isolated effect of metformin.
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.
病例报告提示二肽基肽酶-4 抑制剂（DPP4i）与大疱性类天疱疮（BP）的发生之间存在关联。
评估 DPP4i 治疗与 BP 发生之间的关联。
我们进行了一项回顾性 1:2 病例对照研究，比较了瑞士（伯尔尼）和法国（马赛）皮肤科部门 2014 年 1 月 1 日至 2016 年 7 月 31 日期间患有糖尿病和 BP 的病例患者与年龄和性别匹配的糖尿病对照患者。
我们收集了 61 名患有糖尿病和 BP 的病例患者和 122 名对照患者。DPP4i 与 BP 发生风险增加相关（调整后的优势比，2.64；95%置信区间，1.19-5.85；P=0.02），其中维格列汀显示出最高的调整后优势比（3.57 [95%置信区间，1.07-11.84；P=0.04]）。分层分析显示，男性和 80 岁或以上的患者中存在更强的关联。DPP4i 停药和开始一线治疗导致 95%的病例临床缓解。
这是一项在三级转诊医院进行的回顾性研究。我们将分析重点放在 DPP4i 的摄入上，而没有分析二甲双胍潜在的单独作用。
DPP4i，尤其是维格列汀，与 BP 发生风险增加相关。需要仔细评估其使用，特别是在高风险患者中，如男性和 80 岁或以上的患者。
