Changing prevalence of diabetes mellitus in bullous pemphigoid: it is the dipeptidyl peptidase‐4 inhibitors

Gravani, Agoritsa; Gaitanis, Georgios; Tsironi, Theodora; Tigas, Stelios; Bassukas, Ioannis D.

doi:10.1111/jdv.14957

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…Furthermore, a recent Greek retrospective cohort study observed a 38.4% increase in the prevalence of patients with comorbid type 2 diabetes mellitus in a cohort of 130 patients with BP. This rise was ascribed mainly to the growing prescription of DPP4i ( 69 ). Interestingly, DPP4i may in addition increase the risk for another pemphigoid disease, namely mucous membrane pemphigoid (MMP), where exposure to these agents accounted for 24 cases of a total of 313 MMP patients in a recent French cohort study ( 70 ).…”

Section: Putative Explanations For This Surgementioning

confidence: 99%

The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

2018

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Bullous pemphigoid (BP) is the most common type of subepidermal autoimmune bullous diseases. BP characteristically affects the elderly and is seen mainly in patients older than 70 years. While the annual incidence of BP has been estimated to be between 2.4 and 23 cases per million in the general population, it rises exponentially to 190–312 cases per million in individuals older than 80 years. In addition, a growing body of evidence reports a remarkable trend of increased incidence of BP, showing a 1.9- to 4.3-fold rise over the past two decades. This demonstrable increase warrants a higher awareness of the increased risk to develop BP. This review summarizes the current understanding of the epidemiological features of BP and sheds light on the putative explanations for its growing incidence.

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Section: Putative Explanations For This Surgementioning

confidence: 99%

The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

2018

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“…Higher prevalence of BP may be due to the increasing mean age of the population, more frequent use of provoking drugs, such as loop diuretics, penicillin or PD-1/PD-L1 inhibitors, increased incidence of associated diseases (e.g., neurological diseases or hematologic malignancies), and recognition of atypical types of the disease [ 3 , 4 , 5 , 6 , 7 , 8 ]. However, some studies showed a higher prevalence of diabetes mellitus and a higher number of antidiabetic dipeptidyl peptidase 4 inhibitor (DPP4i) taking patients among BP patients [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. An increasing number of studies showed association of DPP4i and bullous pemphigoid, but the exact mechanism of this association remains unclear [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, some studies showed a higher prevalence of diabetes mellitus and a higher number of antidiabetic dipeptidyl peptidase 4 inhibitor (DPP4i) taking patients among BP patients [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. An increasing number of studies showed association of DPP4i and bullous pemphigoid, but the exact mechanism of this association remains unclear [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. As shown by several recent studies, DPP4i-related BP is associated with an atypical form, characterized by erosions without erythema, decreased eosinophil infiltration around the blisters and negative serological results to NC16A domain of BP180 [ 25 , 26 , 27 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

Kinyó

Hanyecz

Lengyel

et al. 2021

JCM

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Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, p < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, p = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.

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“…It was also suggested that use of DPP-4 inhibitors might be associated with increased risk for developing BP. 24 Sim et al also reported, HT, DM and neurological diseases to be common in patients with BP. 25 Moreover, they emphasized the high incidence of multimorbidity in patients with BP.…”

Section: Discussionmentioning

confidence: 93%

Clinical Features, Associated Systemic Diseases, Mortality Rates, and Treatment Protocols in a Group of Turkish Patients with Bullous Pemphigoid

Serdar¹,

Karabay²,

Yaşar³

et al. 2018

Turkiye Klinikleri J Dermatol

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The aim of the study was to investigate the clinical features, associated systemic diseases, treatment protocols, recurrence rates, and mortality rates in bullous pemphigoid (BP) patients. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The demographic and clinical characteristics of 47 patients with BP were evaluated. 47 age and gender-matched subjects without autoimmune bullous disease were included as the control group. The comorbidities accompanying to BP patients and the diseases in the control group were compared. R Re es su ul lt ts s: : The mean age of the patients was 77.9±10.57 (36-96) years old, and the average disease duration was 39.30±29.54 months. The BP patients were compared with the control group in terms of systemic diseases using a chi-squared test with a 95% confidence interval. No significant differences were found between the BP patients and the control group with regard to the associated systemic diseases, including hypertension (HT), diabetes mellitus (DM), neurological disease, heart disease, malignancy, and other diseases. Systemic corticosteroids (methylprednisolone) were administered to 34 (72.3%) of the patients, while 12 (25%) patients were given methylprednisolone alone. Azathioprine and methotrexate were added to the treatments of 5 (10.6%) and 3 (6.4%) of the cases, respectively. Eight (17%) patients showed recurrences, and the mortality rate was 23.4%. C Co on nc cl lu us si io on n: : Although the results of our study showed that a significant proportion of the BP patients had an accompanying systemic disease, most frequently hypertension and diabetes mellitus, there was not a statistically significant difference in terms of comorbidities between BP patients and controls. Systemic corticosteroids were the most commonly used treatments. Overall, our data from this 7-year period will contribute to the understanding of the characteristics of the BP patients in Turkey. K Ke ey yw wo or rd ds s: : Bullous pemphigoid; comorbidity; mortality; recurrence; therapy Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmanın amacı büllöz pemfigoid (BP) hastalarında klinik özellikleri, ilişkili sistemik hastalıkları, tedavi protokollerini, nüks oranlarını ve mortalite oranlarını araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 47 BP hastasının demografik ve klinik özellikleri değerlendirildi. Yaş ve cinsiyet açısından hasta grubuyla uyumlu olan otoimmün büllü hastalığı olmayan 47 kişi kontrol grubunu oluşturdu. BP hastalarına eşlik eden komorbiditeler ve kontrol grubunda bulunan hastalıklar karşılaştırıldı. B Bu ul lg gu ul la ar r: : Hastaların ortalama yaşı 77.9±10.57 (36-96) yıl ve ortalama hastalık süresi 39.30±29.54 ay idi. BP hastaları kontrol grubuyla sistemik hastalık bulunması açısından ki-kare test kullanılarak %95 güven aralığıyla karşılaştırıldı. BP hastaları ile kontrol grubu arasında hipertansiyon (HT), diabetes mellitus (DM), nörolojik hastalıklar, kalp hastalıkları, malignite gibi eşlik eden sistemik hastalıklar açısından belirgin fark bulunmadı. 34 hastaya (%72...

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Changing prevalence of diabetes mellitus in bullous pemphigoid: it is the dipeptidyl peptidase‐4 inhibitors

Abstract: Linked article: This article is commentary on by L. Fania et al., pp. e439–e440 in this issue. To view this article visit https://doi.org/10.1111/jdv.14965

Cited by 22 publications

References 7 publications

The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations

Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

Clinical Features, Associated Systemic Diseases, Mortality Rates, and Treatment Protocols in a Group of Turkish Patients with Bullous Pemphigoid

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