BACKGROUND: Dipeptidyl peptidase 4 inhibitor (DPP4i) are commonly used for management of diabetes. Although there are reports of increased risk of autoimmune skin blistering disorders (AIBD) with DPP4i, data is scarce. Although the exact mechanism through which DPP4i may cause AIBD is unknown, DPP4i may induce anti-basement membrane zone antibodies. Inhibition of DPP4 enzyme may also result in the recruitment of eosinophils into the dermis.
OBJECTIVES: Examine the incidence of AIBD in DPP4i users compared to non-users.
METHODS: This retrospective cohort study included US veterans who initiated either DPP4i or glucagon like-peptide 1 receptor agonist (GLP1-RA) medications, as active comparator, between 2006 to 2021. We formed a propensity score (PS) matched cohort of DPP4i and GLP1-RA users encompassing 46 baseline characteristics. Our primary outcome was the incidence of AIBD, which included bullous pemphigoid (BP) and pemphigus vulgaris (PV) in the PS-matched cohort.
RESULTS: The study included 266,315 DPP4i users and 149,183 GLP1-RA users. We propensity score-matched 101,220 pairs of DPP4i and GLP1-RA users without residual imbalances. A total of 154 patients developed AIBD. Of those, 123 were DPP4i users (0.05%) and 31 were GLP1-RA users (0.02%). Use of DPP4i compared to GLP1-RA was associated with increased odds of AIBD (odds ratio [OR]: 1.88, 95% confidence interval [95%CI]: 1.02-3.44, = 0.0421) and BP (OR: 1.90, 95%CI: 1.14-3.17, = 0.014) but was not associated with PV (OR: 1.31, 95% CI: 0.65-2.62, = 0.45). p p p
CONCLUSION AND RELEVANCE: Our study supports existing literature indicating that DPP4i is associated with an increased risk of BP.
