Higher frequency of dipeptidyl peptidase IV inhibitor intake in bullous pemphigoid patients than in the French general population.

Dipeptidyl-peptidase-IV-inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0% (95% confidence interval (CI)=4.9-7.1%) versus 3.6%, observed to expected-drug intake ratio=1.7 (95% CI=1.4-2.0),p<0.0001; vildagliptin=3.3% (95%CI=2.5-4.1%) versus 0.7%, ratio=4.4 (95%CI=3.5-5.7),p<0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio=1.8 (95%CI=1.3-2.4, p<0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 cases (45.3%). Median duration to achieve disease control, rate and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.