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As with any medicine, some people experience side effects

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Journal of Medicinal Chemistry, 57(8), 3161-3185

In the case of bullous pemphigoid, an autoinflammatory blistering skin disease, DPP4s role may involve impacting immune cell function and the formation of autoantibodies against skin components

But availability does not automatically equal utilization

The most incompetent non-specialist would have seen something. Upper throat cancers (squamous-cell carcinomas) are quite visible to a scope by nature they mostly grow on the exposed surfaces of the esophagus and trachea where cells have been abused by smoke or booze for decades, especially the combination