Boston, Massachusetts: The use of DPP-4 inhibitor therapy in type 2 diabetes patients (T2D) may lead to a higher risk of bullous pemphigoid as compared to second-generation sulfonylurea therapy, suggests a recent study in the journal JAMA Dermatology.
There is limited evidence on the absolute risk and comparative safety against other antidiabetics despite several recent reports on the elevated risk of bullous pemphigoid in T2D patients treated with dipeptidyl peptidase–4 (DPP-4) inhibitors. Hemin Lee, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and colleagues thus, conducted the study to characterize the incidence rate of bullous pemphigoid associated with DPP-4 inhibitor use compared with second-generation sulfonylureas.
This cohort study used data from 2 large commercial insurance claims databases (Optum Clinformatics Data Mart from October 17, 2006, to December 31, 2018, and IBM MarketScan Research Database from October 17, 2006, to December 31, 2017) and Medicare data from January 1, 2006, to December 31, 2016. It included type 2 diabetes patients (n=1 664 880) who initiated treatment with DPP-4 inhibitors or second-generation sulfonylurea.
The primary outcome of the study was bullous pemphigoid, identified using diagnosis codes.
Key findings of the study include:
The incidence rate of bullous pemphigoid per 1000 person-years was 0.42 in the DPP-4 inhibitor group vs 0.31 in the sulfonylurea group (HR, 1.42).
Higher rates per 1000 person-years for DPP-4 inhibitor vs sulfonylurea groups were seen in those who were 65 years or older (0.79 vs 0.49; HR, 1.62), white (0.93 vs 0.54; HR, 1.70), and treated with linagliptin (1.20 vs 0.55; HR, 1.68).
"This study found that patients who initiated DPP-4 inhibitor therapy had higher risk of bullous pemphigoid than those who initiated second-generation sulfonylurea therapy. Clinicians should be aware of this rare adverse effect of DPP-4 inhibitors in subgroups of patients who are older, white, and linagliptin users," concluded the authors.
The study, "Evaluation of Risk of Bullous Pemphigoid With Initiation of Dipeptidyl Peptidase–4 Inhibitor vs Second-generation Sulfonylurea," is published in the journal JAMA Dermatology.
DOI: 10.1001/jamadermatol.2020.2158