Dipeptidyl-peptidase IV inhibitors (DPP4i)-associated bullous pemphigoid: Estimating the clinical profile and exploring intraclass differences

Data regarding the clinical characteristics of patients with dipeptidyl-peptidase IV inhibitors (DPP4i)-associated BP is inconclusive. We aimed to characterize the clinical features of patients with DPP4i-associated BP, and to assess whether there are phenotypic differences associated with different agents belonging to the DPP4i class. A retrospective prevalence study was performed, including all consecutive patients diagnosed with BP throughout the years 2000 to 2019. The study included 397 patients with BP, of whom 58 (14.6%) were DPP4i-associated. Compared to other patients with BP, patients with DPP4i-associated BP had a more prominent male preponderance (60.3% vs 41.0%; P =.006), presented more frequently with extensive disease (60.3% vs 46.3%; P =.049), had greater truncal (96.6% vs 85.5%; P =.019) and cephalic (51.7% vs 33.6%; P =.008) involvement, and had less frequent peripheral eosinophilia (25.9% vs 51.9%; P <.001). Compared to patients with vildagliptin-associated BP, those with linagliptin-associated BP were managed by higher dosage of systemic corticosteroids in order to achieve disease control (prednisone > 1 mg/kg: 68.2% vs 40.0%; P =.046). In conclusion, DPP4i-associated BP seems to have a unique clinical profile characterized by male predominance, extensive disease, truncal and cephalic involvement, and less peripheral eosinophilia. Linagliptin may be associated with a harder course necessitating more aggressive therapy.