Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes
Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes
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DOI：
10.1001/jamadermatol.2018.4556
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发表时间：
2019-02-01
期刊：
影响因子：
10.9
通讯作者：
Kim, Dong Hyun
中科院分区：
文献类型：
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作者：
Lee, Seon Gu;Lee, Hee Jung;Kim, Dong Hyun
重要性最近的研究表明，二肽基肽酶4（DPP-4）抑制剂与大疱性类天疱疮（BP）的风险增加有关。DPP-4抑制剂和BP. DESIGN之间的关联，以人口为基础的研究是limited.OBJECTIVE的潜在关联DPP-4抑制剂的使用和发展BP.DESIGN，设置，和参与者的风险增加之间的特征这一回顾性，全国范围内，以人口为基础，病例对照研究，使用韩国保险索赔数据从2012年1月1日。至2016年12月31日，包括新诊断的BP和糖尿病患者。对照组糖尿病患者（无BP）的年龄，性别和年的诊断匹配后，随机获得在同一periods.Main结果和措施每年新诊断的BP和糖尿病患者的数量和每年的变化，糖尿病患者的比例在所有患者的BP进行了测量。使用DPP-4抑制剂与发生BP的风险之间的关联使用单变量和多变量logistic回归分析。结果该研究包括670例患者（糖尿病和BP）和670例对照患者（仅糖尿病）（平均[SD]年龄，每组75.3 [10.0]岁;每组342 [51.0%]男性）。在研究期间，糖尿病和BP患者的数量增加了一倍多（从2012年的77人增加到2016年的206人）。糖尿病患者在所有BP患者中的比例也有所增加（从2012年的0.18增加到2016年的0.33）。DPP-4抑制剂的使用与发生BP的风险显著增加相关（调整后的比值比[aOR]，1.58; 95% CI，1.25-2.00; P < .001）;在韩国使用的所有DPP-4抑制剂中，最高aOR与使用vildagelatin相关（aOR，1.81; 95%CI，1.31-2.50; P < .001）。亚组分析显示，男性患者中（aOR，1.91; 95%CI，1.39-2.63; P < .001），并且维达鲁肽是最高风险的DPP-4抑制剂（aOR，2.70; 95% CI，1.73-4.34;结论和相关性研究结果表明，DPP-4抑制剂与糖尿病患者发生BP的风险显著增加相关。在韩国可用的DPP-4抑制剂中，vildaglavine与最高风险相关，尤其是在男性患者中。从业者应考虑DPP-4抑制剂，特别是vildagelide，可能与糖尿病患者BP的发生有关。这些全国性的、以人群为基础的结果可以作为进一步研究的基础，以了解DPP-4抑制剂如何促进BP的发展。
IMPORTANCE Recent studies suggest that dipeptidyl peptidase 4 (DPP-4) inhibitors are associated with an increased risk of developing bullous pemphigoid (BP). Population-based studies on the association between DPP-4 inhibitors and BP are limited.OBJECTIVE To characterize the potential association between the use of DPP-4 inhibitors and an increased risk of developing BP.DESIGN, SETTING, AND PARTICIPANTS This retrospective, nationwide, population-based, case-control study using Korean insurance claims data from January 1, 2012. to December 31, 2016, included patients with newly diagnosed BP and diabetes. Control patients with diabetes (and without BP) were randomly obtained after matching for age, sex, and year of diagnosis within the same period.MAIN OUTCOMES AND MEASURES The number of patients with newly diagnosed BP and diabetes per year and annual changes in the proportion of patients with diabetes among all patients with BP were measured. The association between use of DPP-4 inhibitors and risk of developing BP was analyzed using univariate and multivariate logistic regression analyses.RESULTS The study included 670 case patients (with diabetes and BP) and 670 control patients (with only diabetes) (mean [SD] age, 75.3 [10.0] years in each group; 342 [51.0%] male in each group). The number of patients with diabetes and BP more than doubled during the study period (from 77 in 2012 to 206 in 2016). The proportion of patients with diabetes among all patients with BP also increased (from 0.18 in 2012 to 0.33 in 2016). The use of DPP-4 inhibitors was associated with a significant increase in the risk of developing BP (adjusted odds ratio [aOR], 1.58; 95% CI, 1.25-2.00; P < .001); among all DPP-4 inhibitors used in Korea, the highest aOR was associated with the use of vildagliptin (aOR, 1.81; 95% CI, 1.31-2.50; P < .001). Subgroup analyses revealed a significant association in male patients (aOR, 1.91; 95% CI, 1.39-2.63; P < .001) and that vildagliptin was the most high-risk DPP-4 inhibitor (aOR, 2.70; 95% CI, 1.73-4.34; P < .001).CONCLUSIONS AND RELEVANCE The findings suggest that DPP-4 inhibitors are associated with a significantly increased risk of the development of BP in patients with diabetes. Of the DPP-4 inhibitors available in Korea, vildagliptin was associated with the highest risk, particularly in male patients. Practitioners should consider that DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of BP in patients with diabetes. These nationwide, population-based results may serve as a foundation for further studies seeking to understand how DPP-4 inhibitors contribute to the development of BP.