Risk heterogeneity of bullous pemphigoid among dipeptidyl peptidase-4 inhibitors: A population-based cohort study using Japanese Latter-Stage Elderly Healthcare Database

IF 3.2 3区医学

Journal of Diabetes Investigation Pub Date : 2023-03-10 DOI:10.1111/jdi.14004

Yumi Harano, Yasutaka Mitamura, Peng Jiang, Takako Fujita, Akira Babazono

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引用次数: 1

Abstract

Aims/Introduction

Although the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and bullous pemphigoid (BP) has begun to be established, some studies have suggested there are risk differences among DPP-4 inhibitors. We conducted a population-based cohort study to examine the risk differences.

Materials and Methods

Using the claims databases of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare between April 1, 2013 and March 31, 2017, we conducted a retrospective cohort study to compare patients receiving one DPP-4 inhibitor with those who were prescribed another antidiabetic drug. The primary outcome was an adjusted hazard ratio (HR) of the development of bullous pemphigoid during a 3-year follow-up. The secondary outcome was the development of BP requiring systemic steroids immediately after the diagnosis. These were estimated using Cox proportional hazards regression models.

Results

The study comprised 33,241 patients, of which 0.26% (n = 88) developed bullous pemphigoid during follow-up. The percentages of patients with bullous pemphigoid who required immediate systemic steroid treatment was 0.11% (n = 37). We analyzed four DPP-4 inhibitors: sitagliptin, vildagliptin, alogliptin, and linagliptin. Vildagliptin and linagliptin raised the risk of BP significantly (primary outcome, vildagliptin, HR 2.411 [95% confidence interval (CI) 1.325–4.387], linagliptin, HR 2.550 [95% CI 1.266–5.136], secondary outcome, vildagliptin HR 3.616 [95% CI 1.495–8.745], linagliptin HR 3.556 [95% CI 1.262–10.024]). A statistically significant risk elevation was not observed with sitagliptin and alogliptin (primary outcome, sitagliptin, HR 0.911 [95% CI 0.508–1.635], alogliptin, HR 1.600 [95% CI 0.714–3.584], secondary outcome, sitagliptin, HR 1.192 [95% CI 0.475–2.992], alogliptin, HR 2.007 [95% CI 0.571–7.053]).

Conclusions

Not all the DPP-4 inhibitors could induce bullous pemphigoid significantly. Therefore, the association warrants further investigations before generalization.

Abstract Image

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二肽基肽酶-4抑制剂中大疱性类天疱疮的风险异质性:一项基于人群的队列研究，使用日本晚期老年保健数据库

虽然二肽基肽酶-4 (DPP-4)抑制剂与大疱性类天疱疮(BP)之间的关联已经开始确立，但一些研究表明DPP-4抑制剂之间存在风险差异。我们进行了一项基于人群的队列研究，以检查风险差异。材料与方法利用2013年4月1日至2017年3月31日福冈广域老年保健协会的索赔数据库，我们进行了一项回顾性队列研究，比较服用一种DPP-4抑制剂的患者和服用另一种降糖药的患者。主要结局是3年随访期间发生大疱性类天疱疮的调整风险比(HR)。次要结果是诊断后需要立即全身性类固醇的BP发展。这些是使用Cox比例风险回归模型估计的。结果本研究共纳入33,241例患者，其中0.26% (n = 88)在随访期间出现大疱性类天疱疮。大疱性类天疱疮患者需要立即全身类固醇治疗的百分比为0.11% (n = 37)。我们分析了四种DPP-4抑制剂:西格列汀、维格列汀、阿格列汀和利格列汀。维格列汀和利格列汀显著提高了BP风险(主要结局，维格列汀，危险度2.411[95%可信区间(CI) 1.325-4.387]，利格列汀，危险度2.550 [95% CI 1.266-5.136]，次要结局，维格列汀危险度3.616 [95% CI 1.495-8.745]，利格列汀危险度3.556 [95% CI 1.262-10.024])。西格列汀和阿格列汀未观察到有统计学意义的风险升高(主要结局，西格列汀，HR 0.911 [95% CI 0.508-1.635]，阿格列汀，HR 1.600 [95% CI 0.714-3.584]，次要结局，西格列汀，HR 1.192 [95% CI 0.475-2.992]，阿格列汀，HR 2.007 [95% CI 0.571-7.053])。结论并非所有DPP-4抑制剂均能显著诱导大疱性类天疱疮。因此，在推广之前，这种关联值得进一步调查。

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来源期刊

Journal of Diabetes Investigation Medicine-Internal Medicine

自引率

9.40%

发文量

218

期刊介绍： Journal of Diabetes Investigation is your core diabetes journal from Asia; the official journal of the Asian Association for the Study of Diabetes (AASD). The journal publishes original research, country reports, commentaries, reviews, mini-reviews, case reports, letters, as well as editorials and news. Embracing clinical and experimental research in diabetes and related areas, the Journal of Diabetes Investigation includes aspects of prevention, treatment, as well as molecular aspects and pathophysiology. Translational research focused on the exchange of ideas between clinicians and researchers is also welcome. Journal of Diabetes Investigation is indexed by Science Citation Index Expanded (SCIE).