In the Journals

Risk for autoimmune skin condition may be elevated by DPP-IV use

The skin condition bullous pemphigoid may be more likely to develop in adults with type 2 diabetes who use DPP-IV inhibitors vs. those who do not use the medication, especially if they also use spironolactone or have dementia, according to findings published in the Journal of Diabetes and its Complications.

“A variety of drugs have been reported to be associated with bullous pemphigoid. In patients with type 2 diabetes mellitus, DPP-IV inhibitors are considered … a safer drug with rare side effects among antidiabetic agents,” Ching-Chu Chen, MD, associate professor in the division of endocrinology and metabolism in the department of medicine at China Medical University Hospital and the School of Chinese Medicine at China Medical University in Taiwan, and colleagues wrote. “Hence, clinicians prefer to use DPP-IV inhibitors in hypoglycemia-vulnerable patients. However, many of these patients have some kinds of neurological disease. Furthermore, increasing evidence showed that DPP-IV inhibitor [use] was associated with the development of bullous pemphigoid.”

Chen and colleagues assessed the development of bullous pemphigoid among 14,187 adults who had type 2 diabetes and used DPP-IV inhibitors (mean age, 63.34 years; 47.5% women) and 28,374 adults with bullous pemphigoid who did not use the DPP-IV inhibitor medication class (mean age, 63.3 years; 47.5% women). Data collected between January 2009 and June 2013 in the Taiwan National Health Insurance Database confirmed diagnoses of bullous pemphigoid as well as other potential associated neurological conditions, such as dementia, epilepsy and bipolar disorder. The researchers determined the use of medications such as DPP-IV inhibitors and spironolactone via pharmacy records.

 
The skin condition bullous pemphigoid may be more likely to develop in adults with type 2 diabetes who use DPP-IV inhibitors vs. those who do not use the medication, especially if they also use spironolactone or have dementia.
Source: Shutterstock

Among patients using DPP-IV inhibitors, 15 developed bullous pemphigoid vs. 17 of  those not using the medication type. The researchers further calculated that bullous pemphigoid occurred 1.41 times per 1,000 person-years for those using DPP-IV inhibitors and 0.59 times per 1,000 person-years for those not using the medication type. The researchers noted that this equated to a doubling of bullous pemphigoid risk for DPP-IV inhibitor users vs. nonusers (adjusted HR = 2.14; 95% CI, 1.02-4.5).

There was also heightened bullous pemphigoid risk when comparing patients with dementia vs. without dementia (aHR = 3.55; 95% CI, 1.3-9.66) and those prescribed spironolactone (aHR = 3.06; 955 CI, 1.25-7.51). Conversely, there was reduced bullous pemphigoid risk when comparing those who used metformin vs. those who did not use the medication (aHR = 0.38; 95% CI, 0.18-0.79).   

“This study showed that patients with type 2 diabetes with dementia, taking DPP-IV inhibitors and taking spironolactone had a higher associated risk to develop bullous pemphigoid,” the researchers wrote. “The associated risk was lower in metformin users.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

The skin condition bullous pemphigoid may be more likely to develop in adults with type 2 diabetes who use DPP-IV inhibitors vs. those who do not use the medication, especially if they also use spironolactone or have dementia, according to findings published in the Journal of Diabetes and its Complications.

“A variety of drugs have been reported to be associated with bullous pemphigoid. In patients with type 2 diabetes mellitus, DPP-IV inhibitors are considered … a safer drug with rare side effects among antidiabetic agents,” Ching-Chu Chen, MD, associate professor in the division of endocrinology and metabolism in the department of medicine at China Medical University Hospital and the School of Chinese Medicine at China Medical University in Taiwan, and colleagues wrote. “Hence, clinicians prefer to use DPP-IV inhibitors in hypoglycemia-vulnerable patients. However, many of these patients have some kinds of neurological disease. Furthermore, increasing evidence showed that DPP-IV inhibitor [use] was associated with the development of bullous pemphigoid.”

Chen and colleagues assessed the development of bullous pemphigoid among 14,187 adults who had type 2 diabetes and used DPP-IV inhibitors (mean age, 63.34 years; 47.5% women) and 28,374 adults with bullous pemphigoid who did not use the DPP-IV inhibitor medication class (mean age, 63.3 years; 47.5% women). Data collected between January 2009 and June 2013 in the Taiwan National Health Insurance Database confirmed diagnoses of bullous pemphigoid as well as other potential associated neurological conditions, such as dementia, epilepsy and bipolar disorder. The researchers determined the use of medications such as DPP-IV inhibitors and spironolactone via pharmacy records.

 
The skin condition bullous pemphigoid may be more likely to develop in adults with type 2 diabetes who use DPP-IV inhibitors vs. those who do not use the medication, especially if they also use spironolactone or have dementia.
Source: Shutterstock

Among patients using DPP-IV inhibitors, 15 developed bullous pemphigoid vs. 17 of  those not using the medication type. The researchers further calculated that bullous pemphigoid occurred 1.41 times per 1,000 person-years for those using DPP-IV inhibitors and 0.59 times per 1,000 person-years for those not using the medication type. The researchers noted that this equated to a doubling of bullous pemphigoid risk for DPP-IV inhibitor users vs. nonusers (adjusted HR = 2.14; 95% CI, 1.02-4.5).

There was also heightened bullous pemphigoid risk when comparing patients with dementia vs. without dementia (aHR = 3.55; 95% CI, 1.3-9.66) and those prescribed spironolactone (aHR = 3.06; 955 CI, 1.25-7.51). Conversely, there was reduced bullous pemphigoid risk when comparing those who used metformin vs. those who did not use the medication (aHR = 0.38; 95% CI, 0.18-0.79).   

“This study showed that patients with type 2 diabetes with dementia, taking DPP-IV inhibitors and taking spironolactone had a higher associated risk to develop bullous pemphigoid,” the researchers wrote. “The associated risk was lower in metformin users.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.