Background Gliptins are indicated for diabetes mellitus type-2 (DM-II). They inhibit dipeptidyl peptidase IV (DPP-IV), an enzyme which is responsible for deterioration of incretin hormones. They increase insulemic secretion in manner glucose dependent, therefore they have positive effects in glycaemic control. Several cases of bullous pemphigoid (BP) have been described since they came on the market. Epidermal keratinocytes have DPP-IV, consequently a possible mechanism implied in the pathogenesis of the BP derived from gliptins is the amendment of immune response and/or alteration of antigenic qualities of the epidermal basement membrane.
Purpose To describe one case of BP associated with vildagliptin and revision of the literature of BP associated with gliptins.
Material and methods We made a bibliographic search in the Pubmed database using the keywords ‘Bullous phemphigoid’ and ‘Dipeptidyl peptidase IV inhibitors’. We also tracked one patient with BP associated withvildagliptin.
Results 51-years-old male with DM-II, being treated with vildagliptin 50 mg and metformin 850 mg twice a day. After two months of therapy he developed erythemateous plaques and pruritic blisters. Biopsy confirmed BP diagnosis. Vildagliptin therapy was cancelled but metformin therapy continued and insulin was introduced temporarily. Clobetasol propionate 0.05% foam was prescribed three times a day in a downward trend to cure lesions. Optimum results were obtained with a full recovery.
Literature review 12 articles connected to BP and gliptins were found, all of them case series and, added to that, two authors described all BP cases related to gliptins that were registered in the French and European Database of Pharmacovigilance. This bibliographic review included 239 patients: 47.2% men, 31.7% females and 20.9% unknown. Average age: 77.8. DPP-IV inhibitor: vildagliptin 66.9%, sitagliptin 22.55%, linagliptin 7.9%, saxagliptin 1.6%, anagliptin 0.4%. The average time from start to development of BP was 8.5 months. Therapy: 73.9% with topic corticosteroid, 20.5% oral and 5.4% others. Outcome after withdrawal of gliptins: 70.2% sustained; refractory: 15.4% and 14.2% unknown.
Conclusion Our case and literature review show the connexion between DPP-IV inhibitors and the development of BP. This connexion can be useful in stopping possible adverse reactions, together with considering other therapies and giving the right information to the patient.
No conflict of interest
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