Bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitor – A case report

Abstract

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are one of the mainstay drugs in the management of type 2 diabetes mellitus. It has been well-documented that these class of drugs cause allergic reactions. Bullous pemphigoid (BP) is a blistering skin condition commonly associated with many drugs. Here, we report a case of probable DPP-4i-induced BP in an elderly man, which resolved on discontinuation of the drug. Although this adverse drug reaction has been documented in Western world and Japanese ethnicity, this seems to be the first case report of such occurrence in Indian ethnicity.

Bullous Drug Reaction with Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

“…There are a few reports of cutaneous adverse effects such as bullous reaction, fixed drug eruption, and photosensitivity with sitagliptin. 3 Definite pathogenesis of allergic reactions in the patients taking sitagliptin is unknown. DPP-4 inhibitors are incretin-based drugs used in diabetes mellitus type 2, which act by inhibiting the degradation of incretins and cause increased insulin secretion with alteration of blood glucose levels.…”

“…5 The time period between the exposure of gliptin and the development of BP was variable from 8 days to 36 months. 3 In patients with gliptin-induced BP, most of these autoantibodies have been reported to react to LAD-1 and/or the terminal carboxyl domain of BP180 protein. The analysis of studies based on pharmacovigilance databases suggests an association between DPP-4 inhibitors and bullous pemphigoid, with the majority of affected patients being over 70 years of age.…”