Bullous pemphigoid receiving a novel long-acting dipeptidyl-peptidase-4 (DPP-4) inhibitor omarigliptin in a patient with type 2 diabetes: A case report
Bullous pemphigoid receiving a novel long-acting dipeptidyl-peptidase-4 (DPP-4) inhibitor omarigliptin in a patient with type 2 diabetes: A case report
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2 型糖尿病患者接受新型长效二肽基肽酶 4 (DPP-4) 抑制剂奥格列汀治疗的大疱性类天疱疮：病例报告
DOI：
10.1002/cia2.12162
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hasegawa M
中科院分区：
文献类型：
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作者：
Kasamatsu H;Chino T;Oyama N;Nakaya T;Hasegawa M
在各种用于治疗糖尿病的DPP4i中，欧马格列汀是一种每周一次的口服药物，在日本首次获得全球批准，广泛用于抗糖尿病算法；然而，报告只涉及与其他DPP4i相当的BP的潜在风险。据我们所知，我们报告了第一例接受奥马格列汀治疗的BP患者，其血清IgG靶向BP180-NC16a。(F) 1M nacl分裂皮肤间接免疫荧光显示基底膜区顶侧IgG染色阳性观察性研究和随机对照试验的荟萃分析发现DPP4i与发生BP密切相关，风险增加2- 4倍。2,3然而，除了一个日本病例外，没有关于每周一次，长效DPP4i，奥玛利格列汀或trelagliptin在BP中的原因的实质性报道。证据不足是由于这两种DPP4i仅在日本获得批准的有限营销。考虑到糖尿病本身会增加BP的风险8，医学背景包括其他抗糖尿病药物可能协同改变靶抗原和/或免疫球蛋白亚型的抗原性9以及疾病的基线活动性。由于奥马格列汀独特的药代动力学，IC50值较低（~ 1.6 nmol/L）， 10本病例可能在停用疑似DPP4i后提示长期的皮肤不良事件。
Among various DPP4i used for the treatment of diabetes, omarigliptin is an once-weekly oral agent that received the first global approval in Japan and widely used in anti-diabetic algorithm; however, reports only implicate a potential risk for developing BP comparable with other DPP4i. 1 We report, to our knowledge, the first case of BP receiving omarigliptin, whose serum IgG targets BP180-NC16a.(F) 1M NaCl-split skin indirect immunofluorescence showing positive IgG staining at the roof side of the basement membrane zone Meta-analysis of observational studies and randomized control trials explored a close association of DPP4i in developing BP, with 2-to 4-fold increased risk. 2, 3 However, no substantial reports are available regarding the cause of once-weekly, long-acting DPP4i, omarigliptin or trelagliptin, in BP, except one Japanese case. 1 The poor evidence would be due to the limited marketing that the two DPP4i are approved only in Japan. Considering that diabetic condition per se increases the risk of BP, 8 medical background including other anti-diabetic drugs might cooperatively modify the antigenicity of target antigen (s) and/or immunoglobulin subtypes, 9 as well as baseline activity of the disease. Because of the unique pharmacokinetics of omarigliptin with low IC50 value (~ 1.6 nmol/L), 10 our case may alert prolonged adverse skin events after withdrawal of suspected DPP4i.