Japan:A recent study in The Journal of Dermatology showed that dipeptidyl peptidase-4 inhibitors (DPP-4i) have been linked to cases of rare skin condition, bullous pemphigoid, prompting authors to suggests trying DPP-4i discontinuation followed by supportive care. Vildagliptin and linagliptin were found to be the most common DPP-4i associated with bullous pemphigoid (BP).
The authors wrote, "non-inflammatory and mild cases of DPP-4i associated bullous pemphigoid may resolve spontaneously with supportive care, including DPP-4i discontinuation and no oral corticosteroid therapy."

In patients taking dipeptidyl peptidase-4 inhibitors, many cases of BP have been reported. DPP-4i are the most widely used antidiabetic drug for type 2 diabetes mellitus. However, in Japan, no large-scale survey has been conducted. Therefore, Seiko Sugiyama, Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan, and colleagues aimed to investigated the incidence, clinical presentation, and clinical course of DPP-4i-associated BP (DPP-4i-BP) using epidemiological data from a nationwide registry for BP in a retrospective study.
For this purpose 713 new BP patients at 94 dermatological institutes were registered in 2016, 243 (34.1%) with DPP-4i-BP and 461 (64.7%) with non-DPP-4i-BP. The male-to-female ratio respectively was 1.9 and 0.84. Patients with DPP-4i-BP were predominantly male.
Based on the study, the researchers found the following:
Non-inflammatory BP was more common in DPP-4i-BP (33.3%) than in non-DPP-4i-BP (14.6%), while inflammatory BP was common in both.
No specific subtype or difference in disease severity was evident in DPP-4i-BP.
The most common gliptins administered to DPP-4i-BP patients were vildagliptin (37.2%) and linagliptin (23.8%). DPP-4i intake was discontinued in 79.9% of cases after diagnosis.
Some DPP-4i-BP patients (17.6%) achieved spontaneous remission after discontinuing DPP-4i without requiring the use of systemic corticosteroids and/or adjuvant therapy.
Mean duration to achieve disease control was 2.87 months.
The odds ratio for non-inflammatory BP requiring systemic corticosteroids and/or adjuvant therapy was low (0.52), suggesting that remission was achieved easily with supportive care in that phenotype.
The researchers conclude, "non-inflammatory and mild cases of DPP-4i-BP may resolve spontaneously with supportive care, including the discontinuation of DPP-4i and no oral corticosteroid therapy."
Reference:
Sugiyama S, Yamamoto T, Aoyama Y. Clinical features of dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in Japan: A nationwide retrospective observational study. J Dermatol. 2022 Jul;49(7):697-702. doi: 10.1111/1346-8138.16394. Epub 2022 Apr 27. PMID: 35478414.