Monday, October 3, 2011

Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies.

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Should diabetes patients be on these new incretin drugs long term?

Gastroenterology. 2011 Jul;141(1):150-6. Epub 2011 Feb 18.


BACKGROUND & AIMS: Glucagon-like peptide-1-based therapy is gaining widespread use for type 2 diabetes, although there are concerns about risks for pancreatitis and pancreatic and thyroid cancers. There are also concerns that dipeptidyl peptidase-4 inhibitors could cause cancer, given their effects on immune function.

  • We examined the US Food and Drug Administration's database of reported adverse events for those associated with the dipeptidyl peptidase-4 inhibitor sitagliptin and the glucagon-like peptide-1 mimetic exenatide, from 2004-2009; data on adverse events associated with 4 other medications were compared as controls.
  • The primary outcomes measures were rates of reported pancreatitis, pancreatic and thyroid cancer, and all cancers associated with sitagliptin or exenatide, compared with other therapies.

  • Use of sitagliptin or exenatide increased the odds ratio for reported pancreatitis 6-fold as compared with other therapies (P<2×10(-16)).
  • Pancreatic cancer was more commonly reported among patients who took sitagliptin or exenatide as compared with other therapies (P<.008, P<9×10(-5)).
  • All other cancers occurred similarly among patients who took sitagliptin compared with other therapies (P=.20).

CONCLUSIONS: These data are consistent with case reports and animal studies indicating an increased risk for pancreatitis with glucagon-like peptide-1-based therapy. The findings also raise caution about the potential long-term actions of these drugs to promote pancreatic cancer.

1 comment:

  1. I'm still mulling this over, but at first glance it seems pretty damning. As a criticism though, I have to wonder if in particular exenatide events were over-reported simply because the potential association between exenatide and pancreatitis has been known for at least the last 5 years which would include that time in question.

    Also peculiar is the increase in thyroid cancer which they talk about in the discussion. It might be interesting to include another less common cancer (say ovarian cancer in females) and see if there is a similar association. Because one has to figure that the majority of the physicians prescribing for example exenatide are endocrinologists or those with an interest in Endocrinology and would tend to in general find more thyroid nodules and diagnose more thyroid cancer.


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