Link Between Oral Diabetes Medications and Bullous Pemphigoid

bullous pemphigoid leg
bullous pemphigoid leg
Finnish investigators evaluated the link between diabetes medications other than DPP-4 inhibitors and the risk for BP.

Although dipeptidyl peptidase-4 (DPP-4) inhibitors have been reported to be linked to an increased risk for developing bullous pemphigoid, the use of other oral diabetes medications is not associated with an increased risk for the development of the condition, according to the results of a Finnish nationwide case-control study published in the Journal of the American Academy of Dermatology.

Investigators sought to evaluate the link between diabetes medications other than
DPP-4 inhibitors and risk for bullous pemphigoid. They examined the prevalence of comorbid diabetes in this population, as well as the association between the use of diabetes agents (excluding DPP-4 inhibitors, metformin, and insulin) and bullous pemphigoid by examining Finnish registry data for 3397 patients with the condition and 12,941 patients with basal cell carcinoma who served as controls. The registry included all patients who were diagnosed with bullous pemphigoid in Finland between January 1, 1997, and December 31, 2013.

The diabetes medications evaluated were classified according to pharmacologic subtype: sulfonylureas (eg, glipizide, glimepiride); heterocyclic sulfonamides; combinations of oral glucose-lowering drugs (eg, metformin plus rosiglitazone, metformin  plus pioglitazone); alpha-glucosidase inhibitors; thiazolidinediones (eg, rosiglitazone, pioglitazone); glucagon-like peptide-1 (GLP-1) receptor agonists (exenatide, liraglutide); sodium-glucose cotransporter-2 inhibitors; and other blood glucose-lowering drugs, excluding insulins (eg, guar gum, repaglinide).

Of the study cohort, 19.6% of patients with bullous pemphigoid were found to have type 2 diabetes. There was no association reported between the use of any of the investigated diabetes medications and an increased risk for bullous pemphigoid.

Limitations of the study include its registry-based design, which prevents confirmation of the accuracy of the patients’ diagnoses. Moreover, the risk for bullous pemphigoid among users of GLP-1 receptor agonists could not be evaluated.

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The researchers noted that they believed this to be the first nationwide registry study to demonstrate that conventional oral antidiabetic agents are not associated with an increased risk for bullous pemphigoid, and thus these drugs can be safely used in this population. Generalization of these findings to other patient populations, however, warrants additional study.


Varpuluoma O, Försti A-K, Jokelainen J, et al. Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: a Finnish nationwide case control study [published online May 24, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.030