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To investigate the odds of BP following exposure to DPP4i and to perform a duration-response analysis evaluating the risk of BP in relation to the duration of exposure to the culprit drug. A population-based nested case\u2013control study was performed comparing diabetic patients with BP (<jats:italic>n<\/jats:italic>\u2009=\u20091458) with age-, sex- and ethnicity-matched diabetic control subjects (<jats:italic>n<\/jats:italic>\u2009=\u20096051) with respect to the prevalence of exposure to DPP4i. Adjusted odds ratios (ORs) were estimated by logistic regression. Overall exposure to DPP4i was associated with an 80% increase in the odds of subsequent BP (OR, 1.81; 95% CI, 1.46\u20132.08;<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). In an intraclass analysis, the odds of BP were increased in association with vildagliptin (OR, 3.40; 95% CI, 2.69\u20134.29;<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and sitagliptin (OR, 1.56; 95% CI, 1.33\u20131.84;<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). In a duration-response analysis, the highest likelihood of BP was found 1\u20132\u00a0years after commencing the drug (OR, 2.66; 95% CI, 1.97\u20133.59;<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The odds of BP were increased across all time periods and retained its statistical significance even\u2009\u2265\u20096\u00a0years after the drug initiation (OR, 1.44; 95% CI, 1.09\u20131.91;<jats:italic>P<\/jats:italic>\u2009=\u20090.011). Relative to other diabetic patients with BP, patients with DPP4i-associated BP were more likely to be admitted to inpatient dermatologic wards (OR, 1.66; 95% CI, 1.30\u20132.13;<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and had higher mean(SD) numbers of outpatient dermatologist visits (14.7[14.8] vs. 12.3[13.2], respectively;<jats:italic>P<\/jats:italic>\u2009=\u20090.006). DPP4i should be suspected as a predisposing factor for BP even numerous years after the drug initiation.<\/jats:p>","DOI":"10.1007\/s00403-021-02317-9","type":"journal-article","created":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T07:02:40Z","timestamp":1642230160000},"page":"33-39","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Dipeptidyl-peptidase IV inhibitor (DPP4i) confers increased odds of bullous pemphigoid even years after drug initiation"],"prefix":"10.1007","volume":"315","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-9151","authenticated-orcid":false,"given":"Khalaf","family":"Kridin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly","family":"Avni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Tzur Bitan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erez","family":"Onn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly","family":"Weinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnon D.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,15]]},"reference":[{"key":"2317_CR1","doi-asserted-by":"publisher","first-page":"220","DOI":"10.3389\/fmed.2018.00220","volume":"5","author":"K Kridin","year":"2018","unstructured":"Kridin K, Ludwig RJ (2018) The growing incidence of Bullous pemphigoid: overview and potential explanations. 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None of the other authors have any conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}