Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes Mellitus A Population-Based Matched Case-Control Study GLP-1 and the Risk of Acute Pancreatitis

Singh S, Chang H, Richards TM, et al. — Mon, 08 Apr 2013 00:00:00 GMT

Importance

Acute pancreatitis has significant morbidity and mortality. Previous studies have raised the possibility that glucagonlike peptide 1 (GLP-1)–based therapies, including a GLP-1 mimetic (exenatide) and a dipeptidyl peptidase 4 inhibitor (sitagliptin phosphate), may increase the risk of acute pancreatitis.

Objective

To test whether GLP-1–based therapies such as exenatide and sitagliptin are associated with an increased risk of acute pancreatitis. We used conditional logistic regression to analyze the data.

Design

Population-based case-control study.

Setting

A large administrative database in the United States from February 1, 2005, through December 31, 2008.

Participants

Adults with type 2 diabetes mellitus aged 18 to 64 years. We identified 1269 hospitalized cases with acute pancreatitis using a validated algorithm and 1269 control subjects matched for age category, sex, enrollment pattern, and diabetes complications.

Main Outcome Measure

Hospitalization for acute pancreatitis.

Results

The mean age of included individuals was 52 years, and 57.45% were male. Cases were significantly more likely than controls to have hypertriglyceridemia (12.92% vs 8.35%), alcohol use (3.23% vs 0.24%), gallstones (9.06% vs 1.34), tobacco abuse (16.39% vs 5.52%), obesity (19.62% vs 9.77%), biliary and pancreatic cancer (2.84% vs 0%), cystic fibrosis (0.79% vs 0%), and any neoplasm (29.94% vs 18.05%). After adjusting for available confounders and metformin hydrochloride use, current use of GLP-1–based therapies within 30 days (adjusted odds ratio, 2.24 [95% CI, 1.36-3.68]) and recent use past 30 days and less than 2 years (2.01 [1.37-3.18]) were associated with significantly increased odds of acute pancreatitis relative to the odds in nonusers.

Conclusions and Relevance

In this administrative database study of US adults with type 2 diabetes mellitus, treatment with the GLP-1–based therapies sitagliptin and exenatide was associated with increased odds of hospitalization for acute pancreatitis.

Glucagonlike Peptide 1–Based Drugs and Pancreatitis Clarity at Last, but What About Pancreatic Cancer? Comment on “Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes Mellitus” GLP-1–Based Drugs and Pancreatitis

Gier B, Butler PC. — Mon, 08 Apr 2013 00:00:00 GMT

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is approaching 100 million. Most affected individuals are treated for decades. Not surprisingly, the market for drug treatment of T2DM is worth more than $20 billion per year. The most lucrative drugs are those still protected by patent and deemed worthy of selection despite high expense because of clear advantages over cheaper drugs no longer covered by patent protection.

JAMA Internal Medicine: Pancreatic Disease Topic Collection

Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes Mellitus A Population-Based Matched Case-Control Study GLP-1 and the Risk of Acute Pancreatitis

Glucagonlike Peptide 1–Based Drugs and Pancreatitis Clarity at Last, but What About Pancreatic Cancer? Comment on “Glucagonlike Peptide 1–Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes Mellitus” GLP-1–Based Drugs and Pancreatitis