Clin Mol Allergy. 2021 Dec 06;19(1):24. doi: 10.1186/s12948-021-00164-7.
Angioedema associated with dipeptidyl peptidase-IV inhibitors.
Clinical and molecular allergy : CMA
Nicoletta Cassano, Eustachio Nettis, Elisabetta Di Leo, Francesca Ambrogio, Gino A Vena, Caterina Foti
Affiliations
Affiliations
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy.
- Department of Emergency and Organ Transplantation, School and Chair of Allergy and Clinical Immunology, University of Bari "Aldo Moro", Bari, Italy.
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, "F. Miulli" Hospital, Strada Provinciale per Santeramo Km 4.100, Acquaviva delle Fonti, Bari, Italy. [email protected].
- Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
PMID: 34872575
PMCID: PMC8647342 DOI: 10.1186/s12948-021-00164-7
Abstract
BACKGROUND: Dipeptidyl peptidase-IV (DPP-IV) inhibitors, also known as gliptins, are a class of oral antidiabetic agents. Postmarketing reports have documented the occurrence of angioedema in patients treated with gliptins and it was found that these drugs increased the risk of angioedema in patients concurrently treated with angiotensin-converting enzyme inhibitors (ACEIs). The aim of this manuscript is to provide an overview of the risk of angioedema associated with gliptins.
METHODS: The keywords used for the literature search in the PubMed database included "angioedema" and "dipeptidyl peptidase", "gliptins", or the name of each DPP-IV inhibitor. Articles in English published up to December 2020 were taken into consideration.
RESULTS: The available data appear to rule out a higher risk of angioedema associated with gliptin monotherapy and have revealed an increased susceptibility in patients simultaneously treated with gliptins and ACEIs. However, one single multicenter phase IV trial and case reports, even if very limited in number, have shown that angioedema can also occur during treatment with DPP-IV inhibitors without the concomitant use of ACEIs. The involvement of other drugs and drug interactions has occasionally been suggested. In a few patients, deficiency of enzymes involved in bradykinin catabolism was detected and this finding can constitute a risk factor for angioedema exacerbated by treatment with DPP-IV inhibitors.
CONCLUSIONS: This risk of angioedema associated with the use of gliptins has mostly been related to the concurrent administration of ACEIs, and has been considered rare, but it might be underestimated and underreported. The role of additional risk factors or drug interactions deserves further investigations. Caution should be taken when considering the use of DPP-IV inhibitors in patients treated with ACEIs or presenting with other known risk factors for angioedema.
© 2021. The Author(s).
Keywords: Angioedema; Angiotensin-converting enzyme inhibitors; Bradykinin; Dipeptidyl peptidase-IV inhibitors; Gliptins
References
- Diabetes Care. 2011 May;34 Suppl 2:S276-8 - PubMed
- J Allergy Clin Immunol Pract. 2017 May - Jun;5(3):744-749 - PubMed
- Diabetes Metab Res Rev. 2014 Oct;30(7):556-69 - PubMed
- J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):453-459 - PubMed
- Br J Anaesth. 2012 Nov;109(5):827-9 - PubMed
- Br J Clin Pharmacol. 2016 Dec;82(6):1647-1659 - PubMed
- Ann Allergy Asthma Immunol. 2008 Apr;100(4):327-32 - PubMed
- Arch Intern Med. 2005 Jul 25;165(14):1637-42 - PubMed
- Int J Cardiol. 2013 Oct 3;168(3):e106 - PubMed
- Aust Fam Physician. 2013 Dec;42(12):863-6 - PubMed
- Endocrinol Diabetes Metab. 2019 Jun 21;2(3):e00084 - PubMed
- Hypertension. 2008 Jun;51(6):1624-30 - PubMed
- J Allergy Clin Immunol Pract. 2019 Jul - Aug;7(6):2068-2069 - PubMed
- Immunol Allergy Clin North Am. 2017 Aug;37(3):483-495 - PubMed
- Hypertension. 2009 Sep;54(3):468-70 - PubMed
- J Allergy Clin Immunol. 2007 Aug;120(2):403-8 - PubMed
- Curr Hypertens Rep. 2018 Jun 8;20(7):55 - PubMed
- BMJ Case Rep. 2017 Jan 10;2017: - PubMed
- Eur Ann Allergy Clin Immunol. 2014 May;46(3):119-22 - PubMed
- Expert Opin Drug Saf. 2018 Apr;17(4):387-405 - PubMed
- Ann Intern Med. 2017 Jul 18;167(2):142-143 - PubMed
- J Investig Allergol Clin Immunol. 2020;30(4):272-280 - PubMed
- Curr Opin Allergy Clin Immunol. 2013 Aug;13(4):337-44 - PubMed
- N Engl J Med. 2013 Oct 3;369(14):1317-26 - PubMed
- Hypertension. 2008 Jan;51(1):141-7 - PubMed
- BMC Endocr Disord. 2010 Apr 22;10:7 - PubMed
- Allergy. 2010 Nov;65(11):1381-7 - PubMed
- Am J Case Rep. 2017 May 25;18:576-579 - PubMed
- J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2406-2408.e1 - PubMed
- Best Pract Res Clin Endocrinol Metab. 2009 Aug;23(4):479-86 - PubMed
- Am Heart J. 2011 Oct;162(4):620-626.e1 - PubMed
- Peptides. 1996;17(8):1397-403 - PubMed
- Hypertension. 2009 Sep;54(3):516-23 - PubMed
- BMC Endocr Disord. 2008 Oct 27;8:14 - PubMed
- J Allergy Clin Immunol Pract. 2017 May - Jun;5(3):610-615 - PubMed
- BMJ. 2006 May 20;332(7551):1177-81 - PubMed
- Ann Med. 2014 Dec;46(8):607-18 - PubMed
- Curr Diabetes Rev. 2018;14(4):327-333 - PubMed
- Int Immunopharmacol. 2020 Jan;78:106081 - PubMed
- Acta Cardiol. 2019 Aug;74(4):277-281 - PubMed
- Diabet Med. 2010 Apr;27(4):486-7 - PubMed
- Clin Pharmacol Ther. 1996 Jul;60(1):8-13 - PubMed
- Am J Cardiol. 2012 Aug 1;110(3):383-91 - PubMed
- J Eval Clin Pract. 2004 Nov;10(4):499-509 - PubMed
- Hypertension. 2002 Feb;39(2 Pt 2):460-4 - PubMed
- Am J Ther. 2020 Aug 03;: - PubMed
- Diabet Med. 2013 Apr;30(4):e149-50 - PubMed
- Diabetes Care. 2012 Aug;35(8):e60 - PubMed
- Orphanet J Rare Dis. 2018 May 4;13(1):73 - PubMed
- Nat Rev Endocrinol. 2020 Nov;16(11):642-653 - PubMed
Publication Types