Detection and characterization of IgG, IgE, and IgA autoantibodies in patients with bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors

Detection of anti-BP180 NC16A autoantibodies after the onset of dipeptidyl peptidase-IV inhibitor-associated bullous pemphigoid: a report of three patients

“…Fania et al . showed that DPP4i‐BP with anti‐BP180 NC16A autoAbs had autoAbs targeting multiple epitopes of BP180, which also suggests that epitope spreading occurred in these patients. It is of particular interest to know whether epitope spreading occurs more commonly in DPP4i‐BP than in typical BP.…”

“…Dear Editor , Bullous pemphigoid (BP) is a common autoimmune blistering disorder in which autoantibodies (autoAbs) target two hemidesmosomal components (BP180/collagen XVII and BP230) in basal keratinocytes, and 80–90% of patients with BP have autoAbs targeting the juxtamembranous extracellular NC16A domain of BP180 (anti‐BP180 NC16A autoAbs) . Recently, increasing numbers of patients with BP associated with the administration of dipeptidyl peptidase‐IV inhibitors (DPP4i) for the treatment of type 2 diabetes have been reported, although the association remains controversial . Our recent reports suggested that DPP4i‐associated BP (DPP4i‐BP) tends to show a ‘noninflammatory’ phenotype characterized by no or mild erythema, and these patients with DPP4i‐BP have autoAbs that preferentially target the mid‐portion of the extracellular domain of BP180 but not the NC16A domain .…”

“…In addition, the use of DPP4i in our patients had been continued after the onset of BP. Notably, during the prolonged use of DPP4i after BP onset, epitope spreading occurred and the BP was exacerbated by the development of erythema . Thereafter, a persistent or relapsing disease course was observed.…”

Alogliptin‐induced bullous pemphigoid associated with HLA‐DQB1*03:01: a case report

“…Therefore using two methods, we performed a causality assessment of adverse drug reactions (ADR) due to alogliptin. The Naranjo score was 5, indicating a probable ADR, although the previously reported case was possible ADR . With the World Health Organization ‐ Uppsala Monitoring Centre causality assessment scale, alogliptin‐induced ADR in this case was also probable .…”

“…Dipeptidyl peptidase‐4 (DPP‐4) enzyme inhibitors are a class of oral antidiabetic drugs known to induce bullous pemphigoid (BP), but only few cases of alogliptin‐induced BP have been reported . Herein, we report a conclusive case of BP that occurred after alogliptin administration.…”