CHARLOTTE, N.C. — Several factors influence the risk of acute pancreatitis in patients who start taking glucagon-like peptide (GLP-1) receptor agonist drugs for weight management, new research reveals. I was.
Type 2 diabetes, advanced chronic kidney disease, and smoking were associated with an increased risk of acute pancreatitis, researchers report.
On the other hand, a higher body mass index (BMI) – 36 kg/m2 More than — appeared to protect people from developing the condition.
“As this class of medicine becomes more prevalent in the United States, it is important that providers know which patients are at high or low risk of developing acute pancreatitis after initiation. Gastroenterology, University of Texas Southwestern Medical Center, Dallas.” Internal medicine resident.
The findings were presented in person and virtually at the 2022 Annual Scientific Meeting of the American College of Gastroenterology (ACG) in Charlotte, North Carolina.
Popularity comes at a price
The U.S. Food and Drug Administration has approved two GLP-1s for weight management: liraglutide (Victoza) in 2014 and semaglutide (Wegovy) in 2021. They work by targeting areas of the brain that control food intake and appetite. His other GLP-1s approved for the treatment of type 2 diabetes include dulaglutide (Trulicity) and two other formulations of semaglutide (Rybelsus and Ozempic).
Demand for Wegovy is so great that the drug continues to be in short supply in the United States.
Although GLP-1 has shown a favorable side effect profile compared to other types of anti-obesity drugs, researchers noted that acute pancreatitis remains a serious and sometimes life-threatening complication. Some patients require hospitalization.
Postlethwaite et al. conducted a single-center, retrospective study of 2245 patients who participated in the weight wellness program at an academic medical center between 2015 and 2019. The average age was approximately 50 years and 81% were female.Mean BMI for all patients was 39.7 kg/m2.
This study only included patients who were not diabetic and started on GLP-1 for the treatment of obesity.
Of 2245 patients, 49 (2.2%) developed acute pancreatitis after initiation of GLP-1.
Having a history of type 2 diabetes doubles the chance of acute pancreatitis (95% confidence interval [CI]1.04 – 3.96; P. = .04).
Chronic kidney disease of stage 3 or higher was associated with a 2.3-fold increased risk (95% CI, 1.18 – 4.55; P. = .01), 3.3-fold with tobacco use (95% CI, 1.70 – 6.50; P. < .001).
In contrast, researchers found people with BMIs between 36 and 40 kg/m.2 88% less likely to develop acute pancreatitis (95% CI, 0.07 – 0.67; P. = .007) compared with patients with BMI ≤ 30 kg/m2. Patients with a BMI of 40 kg/m or more2 73% reduction in risk (95% CI, 0.10 – 0.73; P. = .01).
Postlethwaite et al found no association with age, sex, history of bariatric surgery or acute pancreatitis.
A history of acute pancreatitis was not a risk factor, and clinicians advised not to withhold these drugs for this reason.
“We hope to provide evidence to clinicians to risk-stratify patients and identify those at increased risk of developing pancreatitis,” Postlethwaite said.
“Hopefully, we can prevent the development of pancreatitis in some patients, especially in high-risk individuals, or at least early enough for clinicians to become aware of pancreatitis in high-risk patients and prevent complications of acute pancreatitis.” We hope that we will be able to identify it in the future,” he added.
Larger studies needed
Baharak Moshiree, M.D., a gastroenterologist at Atrium Health in Charlotte, North Carolina, and co-chair of the session, said the study was “promising,” although he was not involved in the study.
However, because the study was retrospective and relatively small, it needs to be validated in a larger prospective study, she added.
“Because obesity is such a global problem, we have many patients taking these GLP-1 agonists,” said Moshiree.
In general, she notes, these drugs are prescribed by an endocrinologist, not a gastroenterologist, who is responsible for mild gastrointestinal symptoms such as nausea and vomiting that can occur due to delayed gastric emptying. He said we need to be aware of the risks associated with them, including the side effects of
A limitation, Postlethwaite noted, is the inability to assess how much alcohol or tobacco an individual has used. The relatively low proportion of people who developed acute pancreatitis in this study also means that larger studies are needed, he added.
In the future, Postlethwaite and colleagues hope to study the risks of individual GLP-1 and other treatments used to control hyperglycemia in patients with type 2 diabetes, such as DPP4 (dipeptidyl peptidase 4) inhibitors. increase.
American College of Gastroenterology (ACG) 2022 Annual Scientific Meeting: ACG Newsworthy Abstract 18. Published October 24, 2022.
This research was independently supported. Postlethwaite and Moshiree have not reported any related financial relationships.
Damian McNamara is a Miami-based staff journalist. We cover a wide range of clinical departments, including infectious diseases, digestive diseases, and critical care. Follow Damian on Twitter. @MedReporter.
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