Fortis Flt.Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, India.
Fortis-C-DOC Hospital, Diabetes, Endocrinology and Allied Specialties, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation(N-DOC), New Delhi, India; Diabetes Foundation India (DFI), New Delhi, India.
Diabetes Metab Syndr. 2020 May-Jun;14(3):213-216. doi: 10.1016/j.dsx.2020.03.001. Epub 2020 Mar 4.
Dipeptidyl peptidase 4 (DPP4) inhibitors have increasingly been linked to bullous pemphigoid, but there is paucity of data from India where about 1.85 million patients have been estimated to use these drugs.
In 30,000 patients with T2DM seen by us in two tertiary care centres since 2015, we detected 13 cases of bullous pemphigoid linked to DPP4 inhibitors. We used WHO-UMC (World Health Organisation-Uppsala Monitoring Centre) causality assessment system for assessment.
Lesions of bullous pemphigoid appeared at varied intervals (within 1 weeks-2 years) after start of DPP4 inhibitors. Implicated drugs were Linagliptin (n, 8), Vildagliptin (n, 4) and Sitagliptin (n, 1). Mostly, lesions were seen after 60 years age, and over trunk and extremities. Skin biopsy was compatible with bullous pemphigoid in two patients. Lesions regressed within a month of stopping DPP4 inhibitors in 9 patients while delayed regression up to 6 months in 4 patients. Overall, skin lesions remitted in all patients and did not recur.
Any new bullous lesion appearing while patient is on DPP4 inhibitors should be considered as bullous pemphigoid and should necessitate prompt withdrawal of the drug.
二肽基肽酶 4（DPP4）抑制剂与大疱性类天疱疮的关联性日益增加，但来自印度的数据却很少，据估计，印度有 185 万患者正在使用这些药物。
自 2015 年以来，我们在两家三级护理中心共诊治了 2 万名 2 型糖尿病患者，发现了 13 例与 DPP4 抑制剂相关的大疱性类天疱疮病例。我们使用世界卫生组织-乌普萨拉监测中心（WHO-UMC）因果关系评估系统进行评估。
大疱性类天疱疮的病变在开始使用 DPP4 抑制剂后出现不同的时间间隔（1 周至 2 年）。涉及的药物有利拉利汀（n=8）、维格列汀（n=4）和西他列汀（n=1）。大多数患者年龄在 60 岁以上，病变主要出现在躯干和四肢。两名患者的皮肤活检与大疱性类天疱疮相符。9 名患者在停用 DPP4 抑制剂后 1 个月内皮肤病变消退，4 名患者延迟至 6 个月后才消退。总的来说，所有患者的皮肤病变都消退了，且未复发。
任何新出现的大疱性皮肤病变在患者使用 DPP4 抑制剂时，都应被视为大疱性类天疱疮，并应立即停用该药物。
