title: Relative risk of acute pancreatitis in initiators of exenatide twice daily compared with other anti-diabetic medication: a follow-up study.
abstract: OBJECTIVE
  Previously, a retrospective cohort study found no increased risk of acute pancreatitis with current or recent use of exenatide twice daily compared with use of other anti-diabetic drugs. This follow-up study investigated incident acute pancreatitis, with the use of a different data source and analytic method, in patients exposed to exenatide twice daily compared with patients exposed to other anti-diabetic medications.
  
  
  METHODS
  A large US health insurance claims database was used. Eligible patients had ≥ 9 months continuous enrollment without a claim for pancreatitis and a claim for a new anti-diabetic medication on or after 1 June 2005 to 31 March 2009. Cases of acute pancreatitis were defined as hospitalized patients with an Internation Classification of Disease 9 code of 577.0 in the primary position. A discrete time survival model was used to evaluate the relationship between exenatide twice daily and acute pancreatitis.
  
  
  RESULTS
  Of 482,034 eligible patients, 24,237 initiated exenatide twice daily and 457,797 initiated another anti-diabetic medication. Initiators of exenatide twice daily had more severe diabetes compared with initiators of other anti-diabetic medications. After adjustments for propensity score, insulin and use of medication potentially associated with acute pancreatitis, the odds ratio with exenatide twice daily exposure was 0.95 (95% CI 0.65-1.38). A secondary analysis that examined current, recent and past medication exposure found no increased risk of acute pancreatitis with exenatide twice daily, regardless of exposure category.
  
  
  CONCLUSIONS
  This study indicates that exposure to exenatide twice daily was not associated with an increased risk of acute pancreatitis compared with exposure to other anti-diabetic medications. These results should be interpreted in light of potential residual confounding and unknown biases.
authors.affiliation: Amylin Pharmaceuticals Inc., San Diego, CA, USA. made.wenten@amylin.com
authors.forename: M
authors.initials: M
authors.lastname: Wenten
authors.forename: J A
authors.initials: JA
authors.lastname: Gaebler
authors.forename: M
authors.initials: M
authors.lastname: Hussein
authors.forename: E M
authors.initials: EM
authors.lastname: Pelletier
authors.forename: D B
authors.initials: DB
authors.lastname: Smith
authors.forename: P
authors.initials: P
authors.lastname: Girase
authors.forename: R A
authors.initials: RA
authors.lastname: Noel
authors.forename: D K
authors.initials: DK
authors.lastname: Braun
authors.forename: G L
authors.initials: GL
authors.lastname: Bloomgren
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D004334:Drug Administration Schedule; D000077270:Exenatide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000139:chemically induced* / Q000453:epidemiology; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology; D014688:Venoms / Q000008:administration & dosage* / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D000077270:Exenatide