Gliptin-induced bullous pemphigoid: withdrawal of gliptin allows for faster control of the disease

ABSTRACT

Background: Gliptins, also called dipeptidyl peptidase-4 inhibitors, have been incriminated in the development of bullous pemphigoid (BP). To date, there are no recommendations regarding the therapeutic approach for BP during gliptin intake. Objectives: The aim of this retrospective study was to evaluate the evolution of BP after three months relative to continuation or discontinuation of gliptin. Materials & Methods: From a series of 372 patients with BP, 40 taking gliptin were included (January 2009 to December 2019). The primary endpoint was complete response, three months after BP diagnosis based on gliptin continuation or discontinuation. The secondary endpoints were complete response after one month and six months. Results: Of BP patients, 67.5% were taking vildagliptin. BP was diagnosed at a mean period of 28.8 months after gliptin initiation. Gliptin was continued and discontinued each in 20 patients. Three months after diagnosis, patients who stopped gliptin had a significatively better clinical status (p = 0.0006). Thirteen patients had complete response when gliptin was stopped, compared to one patient when gliptin was continued. This difference was maintained after six months (p = 0.0031). There was no difference between the treatments received by patients who stopped gliptin and those who continued treatment (p = 0.7515). Conclusion: In this retrospective study, two groups were compared; one that continued gliptin and the other that stopped the drug. The results obtained suggest that stopping gliptin allows for a complete response rate at three months and six months, whereas gliptin maintenance did not allow for complete response.