Gliptin-Induced Bullous Pemphigoid: Canadian Case Series of 10 Patients

Abstract

Background Bullous pemphigoid (BP) is a chronic immune-mediated vesiculobullous disorder. Recently, several reports have described dipeptidyl peptidase-4 inhibitors, also known as gliptins, as causative agents for drug-induced BP. Objective To report and describe clinical and histologic characteristics of 10 cases of gliptin-induced BP. Results We identified 10 patients with gliptin-induced BP. Nine were secondary to linagliptin, and 1 case was attributed to sitagliptin. All patients showed significant improvement after withdrawal of gliptin medications and proper medical treatment. There has been no evidence of relapse after 4 months of follow-up. Conclusion This report supports the proposed association between gliptins and BP. Physicians should be aware of this potential adverse effect, as gliptin-induced BP can be reversible once identified and the responsible medication is stopped. Early withdrawal of the offending drug and proper treatment can lead to rapid improvement and reduced morbidity.

A Patient With Diabetes and Spontaneous Blistering of the Right Lower Extremity

“…1,8 Recent case reports have described the development of bullous pemphigoid after initiation of dipeptidyl peptidase 4 inhibitors, such as sitagliptin and saxagliptin, in patients with diabetes, with improvement after the gliptin medication was discontinued. 9 Treatment of bullosis diabeticorum involves gentle wound care and prevention of infection. Because bullae on the feet and lower legs can limit mobility and may be associated with an increased risk of unintentional rupture, potentially resulting in large areas of denuded skin, a sterile needle can be used to aspirate large bullae.…”

Dipeptidyl-Peptidase 4 Inhibitor-Induced Variants of Bullous Pemphigoid: A Case Series of Four Patients

“…Some previous studies have approved complete remission after rapid discontinuation of drug with a different median time from 10 to 35 days, while others have seen no major change in remission between the group who continued gliptins and the group with discontinuation. However, it is generally suggested that ceasing the drug would be effective in complete remission because, based on a study, ongoing drug administration and long exposure might lead to neoepitope formation and a more complicated disease cycle [ 1 , 4 , 5 , 19 ].…”

“…Bullous pemphigoid (BP) is the most common acquired autoantibody blistering disease that is idiopathic and has shown a great tendency to develop in older adults [ 1 , 2 , 3 , 4 ]. The characteristic of the disease is that it mainly affects the trunk and the extremities, which can appear as several pruritic tense bullae and erythematous plaque [ 5 ]. The increasing number of BP cases is shown to be related to the increasing rate of senility, stimulated by different drugs like antibiotics and antidiabetic agents, and the ability of better diagnosis as a result of more attention paid to rare types of disease [ 1 , 6 ].…”

Cutaneous Reactions to Antidiabetic Agents: A Narrative Review

“…Pemphigoid reactions are seen to occur most frequently, with 76 of the cases attributed to this adverse event [14]. Cutaneous reactions discussed in the literature fall into the subcategories of immunologic CADRs exanthematous (generalized skin eruption [57], maculopapular eruption [58], and DRESS syndrome [59]), blistering (pemphigoids [60][61][62][63][64][65][66][67], SJS [68], TEN [68], fixed drug eruption [69]), hypersensitivity vasculitis [68], and photosensitivity [70]…”

“…There is continuity between the FDA reporting system and what is found in the literature regarding DPP-4 inhibitors. Twenty-one presentations of bullous pemphigoid were found within case reports and case series, with the majority arising from the administration of vildagliptin [60][61][62][63][64][65][66][67]. Described as erythematous plaques and tense, pruritic blisters without mucosal involvement, drug-induced bullous pemphigoid presented anywhere between 2-37 months after medication initiation.…”