GLP-1RA medications for Type 2 diabetes, obesity may lower risk of acute pancreatitis

Physicians have hesitated to prescribe GLP-1RA medications, such as those with brand names of Ozempic and Victoza, to patients with a history of pancreatitis because it was believed they could increase the risk of acute pancreatitis.

Now, researchers from the Jacobs School of Medicine and Biomedical Sciences at UB report their research has found that these medications don’t put these patients at increased risk for pancreatitis, and the drugs may actually lower their risk.

The work was presented on June 1 at ENDO 2024 in Boston.

“Our clinic often sees patients with a history of pancreatitis who could benefit from GLP-1RA treatments,” says Mahmoud Nassar, a fellow in the Division of Endocrinology, Diabetes and Metabolism in the Department of Medicine at the Jacobs School. “However, due to existing warnings, we were cautious about using these drugs in this group of patients.”

Nassar explains the warnings were due to post-marketing reports that had linked these medications to pancreatitis. However, he and colleagues had reason to think the opposite might actually be true.

“GLP-1RA drugs work through a mechanism that not only controls diabetes and aids in weight loss, but also has anti-inflammatory properties, which likely contributed to the reduced risk,” Nassar says. “We were not surprised to find these drugs reduce the risk of pancreatitis.”

GLP-1RA stands for glucagon-like peptide-1 receptor agonists. GLP-1 is a naturally occurring hormone that helps regulate blood sugar levels and appetite. GLP-1RAs work by mimicking the effects of GLP-1, which helps lower blood sugar levels and promote weight loss.

Researchers used data from a large database called TriNetX, which contains information from about 127 million patients across 15 countries, mainly from the United States. They identified 638,501 individuals with a history of acute pancreatitis; they focused on those with diabetes and obesity who had been diagnosed with acute pancreatitis.

Their analysis covered a wide range of medications within each category to understand how each might affect pancreatitis risk. They also looked closely at different patient characteristics, such as age, gender, body mass index (BMI) and blood test results, to better understand patient groups.

To determine the risk of pancreatitis, they tracked how many patients developed pancreatitis again within five years of starting their medication. They compared groups of patients taking different medications that are prescribed for diabetes, matching them by patient characteristics.

The UB researchers found that patients taking sodium-glucose cotransporter 2 inhibitors, a drug prescribed for diabetes, chronic kidney disease and heart failure, had an incidence of acute pancreatitis recurrence of 24%, while patients in the GLP-1RA group showed a lower risk at 15.2%.

Patients taking dipeptidyl peptidase4 drugs (DPP4i) — a Type 2 diabetes drug — had an incidence of acute pancreatitis recurrence of 23.3% versus 14.4% for those in the GLP-1RA group.

The incidence of acute pancreatitis recurrence for patients taking none of these medications was 51.6% compared to 14.5% for those in the GLP-1RA group.

Nassar says the findings underscore the importance of post-marketing clinical research.

“Our research offers good news for patients with a history of pancreatitis,” he says. “They can now use GLP-1RA drugs to effectively manage Type 2 diabetes and obesity without an increased risk of pancreatitis, expanding their treatment options.”