Gliptins raise risk of acute pancreatitis in type 2 diabetes

Last Updated: 2016-09-28

By David L. Levine

NEW YORK (Reuters Health) - Treatment with gliptins signicantly increase the risk of acute pancreatitis in patients with type 2 diabetes, according to a new meta-analysis.

However, the difference in absolute risk was small, at 0.13%, researchers report in Diabetes Care, online September 22.

The study combined data from three trials that were designed to test cardiovascular safety and efcacy of add-on treatment with a gliptin; SAVOR-TIMI 53 (saxagliptin), EXAMINE (alogliptin), and TECOS (sitagliptin). The trials included more than 18,000 gliptin-treated patients and a comparable number of placebo-treated patients.

Dr. Ivan Tkac of Safarik University in Kosice, Slovakia, told Reuters Health by email, "there has been an ongoing discussion about acute pancreatitis as a side effect of incretin-based drugs (both GLP1-receptor agonists and DPP-4 inhibitors) since they were introduced to the market about 10 years ago."

"The results in the reports were controversial because of different biases," said Dr. Tkac, who worked on the analysis with Dr. Itamar Raz of Hadassah Hebrew University Hospital in Jerusalem, Israel. "Health register studies had a tendency to over-report the risk while observational studies were not able to adjust for the presence of risk factors for acute pancreatitis."

Dr. Tkac and Dr. Raz found that compared with the control group, patients on gliptins had significantly higher odds of developing acute pancreatitis (odds ratio, 1.79; p=0.013), although the absolute risk remained small.

"The risk corresponds to one extra case of acute pancreatitis a year for every 1,000 treated patients," said Dr. Tkac. "The rational change in clinical practice would be not to prescribe DPP-4 inhibitors to patients who are at increased risk of acute pancreatitis such as alcohol abusers, patients with previous acute pancreatitis, patients with chronic pancreatitis, and subjects with severe hypertriglyceridemia. Physicians should make sure that the patients do not have any of these conditions before prescribing this group drugs."

Dr. Robert E. Ratner, chief scientific and medical officer of the American Diabetes Association told Reuters Health by phone that since the data were already known, the study did not break new ground.

"The study confirms a very small risk using these drugs which is reflected in both the literature as well as the package insert. The meta-analysis showed a 0.13% absolute increased risk which is very small but could be important for patients with an individual history of pancreatitis or other risk factors," Dr. Ratner said.

SOURCE: http://bit.ly/2dzduPC

Diabetes Care 2016.