DPP-4 inhibitors may induce bullous pemphigoid or mucous membrane pemphigoid

Drugs that may induce bullous pemphigoid or mucous membrane pemphigoid

In particular, there is increasing support for an association between dipeptidyl peptidase-4 (DPP-4) inhibitors and the development of bullous pemphigoid (BP) and bullous pemphigoid (MMP). A case-control study of 82 patients with BP and diabetes and 328 age- and sex-matched controls with diabetes but without BP found an association between DPP-4 inhibitor intake and the development of BP (adjusted odds ratio [OR] 3.2, 95% CI 1.9-5.4). BP was associated with use of vildagliptin (adjusted OR 10.7, 95% CI 5.1-22.4) and linagliptin (adjusted OR 6.7, 95% CI 2.2-19.7), but not sitagliptin. Patients younger than 70 years and males exhibited the strongest associations between DPP-4 inhibitor use and BP. Mucosal involvement in BP was more common in DPP-4 inhibitor-exposed patients. Patients who discontinued DPP-4 inhibitors appeared to have better outcomes from standard BP therapy than those who continued DPP-4 inhibitor use.

Systemic

Actinomycin D

Amlodipine

Arsenic

Azapropazone (NSAID, not currently available)

Captopril (thiol*)

Celecoxib

Cephalexin

Ciprofloxacin

Clonidine

Chloroquine

Dipeptidyl peptidase-4 inhibitors (gliptins), including sitagliptin and vildagliptin

Efalizumab

Enalapril

Erlotinib

Fluoxetine

Flupenthixol (thiol*)

Furosemide (sulfonamide*)

Gabapentin

Galantamine hydrobromide

Gold thiosulfate (thiol*)

Hydrochlorothiazide

Ibuprofen

Interleukin-2

Levetiracetam

Levofloxacin

Lisinopril

Losartan

Mefenamic acid

Methyldopa

Nadolol

Nifedipine

Omeprazole

PD-1 and PD-L1 monoclonal antibodies, including nivolumab, pembrolizumab, and durvalumab

Penicillamine (thiol*)

Penicillins, including amoxicillin and ampicillin

Phenacetin

Placental extracts

Potassium iodide

Practolol

Psoralens with ultraviolet A (PUVA)

Rifampin

Risperidone

Spironolactone

Sulfasalazine (sulfonamide*)

Sulfamethoxazole (sulfonamide*)

Terbinafine

Tiopronin (thiol*)

Tiobutarit, D Penicillamine analog (thiol*)

Tolbutamide (sulfonamide*)

Tumor necrosis factor-alpha inhibitors, including adalimumab and etanercept

Ustekinumab

Topical

Anthralin

Benzyl benzoate

Coal tar

5-fluorouracil

Iodophor in adhesive bandage

Epinephrine

Idoxuridine

Pilocarpine

Timolol

NSAID: nonsteroidal anti-inflammatory drug; PD-1: programmed death; PD-L1; programmed death-ligand 1.

* Thiol compounds and sulfonamide derivatives are common inducers of pemphigoid.

Original figure modified for this publication. Vassileva S. Drug-induced pemphigoid: Bullous and cicatricial. Clin Dermatol 1998; 16:379.

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REF. upToDate 2020.08.05