Association between dipeptidyl peptidase-4 inhibitors and risk of bullous pemphigoid in patients with type 2 diabetes: A population-based cohort study

Aims: Higher bullous pemphigoid (BP) risk has been reported to be associated with dipeptidyl peptidase 4 inhibitor (DPP4i). The aim of this study is to examine the association between BP risk and DPP4i treatment. Methods: We conducted a nationwide cohort study based on the Taiwan National Health Insurance Database between 2000 and 2015. 124,619 diabetic patients who were receiving DPP4i therapy were matched 1: 1 with diabetic patients who had never received DPP4i by age, sex, duration of diabetes, insulin usage, and propensity score-matching of comorbidities. Results: The 6-year cumulative incidence of BP in the DPP4i-treated cohort was significantly higher than that in the non-DPP4i group (0.74 per 1000 us 0.38 per 1000, P = 0.001). Modified Cox regression analysis revealed that DPP4i treatment (HR: 2.15, 95% CI: 1.18-3.91, P = 0.01), age (HR: 1.06, P < 0.001), renal disease (HR: 2.32, P < 0.001), and metformin user (HR: 1.93, P = 0.006) were associated with increased BP risk. Conclusions: DPP4i users had a 2.2-fold increase in the risk of BP, and the risk was the highest in those with concomitant use of DPP4i and insulin. (C) 2020 Elsevier B.V. All rights reserved.

Automated summary

This study found that diabetic patients treated with DPP4 inhibitors had a significantly increased risk of bullous pemphigoid, especially when used concurrently with insulin.