Background: Previous studies have raised the possibility that GLP-1–based therapies may increase the risk of acute pancreatitis. Clinical question: Are exenatide (GLP-1 mimetic) and sitagliptin (dipeptidyl peptidase 4 inhibitor) associated with an increased risk of acute pancreatitis? Study design: A population-based case-control study using a large administrative database of adults with type 2 diabetes (JAMA Intern Med. 2013 Feb 25:1-6). Findings: Treatment with sitagliptin and exenatide was associated with an approximately two-fold increase in the odds of hospitalisation for acute pancreatitis. Imperial Centre for Endocrinology (ICE) Views: This study adjusted for confounding factors e.g. obesity, gallstones and hypertriglyceridaemia. However, alcohol, tobacco abuse and obesity are undercoded in claims. Misclassification of cases may have occurred due to lack of access to the clinical records. Approximately 3 cases of acute pancreatitis were detected per 1000 patients with type 2 diabetes. Therefore, the absolute risk of pancreatitis is still very low even if the suggested increase in the odds of pancreatitis with GLP-1-based therapies is true. This paper is unlikely to change our clinical practice. The risk/benefit of GLP-1-based therapy in patients with other risk factors for pancreatitis should be considered on a case-by-case basis. |
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