Association between sodium-glucose co-transporter 2 inhibitors and risk of bullous pemphigoid in patients with type 2 diabetes: a nationwide population-based cohort study

Background Certain anti-diabetic agents have been linked to the development of bullous pemphigoid (BP). However, the relationship between BP and sodium-glucose co-transporter 2 inhibitors (SGLT2is) remains inconclusive. Objective To investigate the association between SGLT2i usage and BP. Methods Participants were recruited from the Taiwan National Health Insurance Database between 2007 and 2018. A total of 149 060 patients with diabetes receiving SGLT2i were matched 1 : 2 with diabetic patients without SGLT2i usage. Factors such as age, sex, duration of diabetes condition, DPP4i usage, insulin usage and selected comorbidities were included in the multivariate analysis. Results Compared with the control, the 2-year-cumulative incidence was significantly low in patients using SGLT2i after adjustment for competing mortality. Patients with diabetes receiving SGLT2i had a low risk [adjusted hazard ratio (HR) 0.56, 95% confidence interval (CI), 0.33-0.96] for BP after adjustment for potential confounders. Age (HR, 1.06), renal disease (HR, 1.79), cerebrovascular disease (HR, 3.23), epilepsy (HR, 3.07), DPP4i users (HR: 2.55) and insulin users (HR: 2.56) were significant risk factors for BP. Conclusions The risk of BP did not increase in patients receiving SGLT2i. Thus, SGLT2i could be a safe choice for patients with diabetes having additional risk factors or a history of BP.

Automated summary

This study found that the use of SGLT2 inhibitors is not associated with an increased risk of bullous pemphigoid (BP) in patients with diabetes. Age, renal disease, cerebrovascular disease, epilepsy, DPP4 inhibitor usage, and insulin usage were significant risk factors for BP. SGLT2 inhibitors may be a safe choice for patients with diabetes who have additional risk factors or a history of BP.