title: Incretin-based therapies and acute pancreatitis risk: a systematic review and meta-analysis of observational studies.
abstract: Concerns raised by several animal studies, case reports, and pharmacovigilance warnings over incretin-based therapy potentially exposing type two diabetes patients to an elevated risk of pancreatitis have cast a shadow on the overall safety of this class of drugs. This systematic review evaluates the data from observational studies that compared treatment with or without incretins and the risk of pancreatitis. We searched PubMed for publications with the key terms incretins or GLP-1 receptor agonists or DPP-4 inhibitors or sitagliptin or vildagliptin or saxagliptin or linagliptin or alogliptin or exenatide or liraglutide AND pancreatitis in the title or abstract. Studies were evaluated against the following criteria: design (either cohort or case-control); outcome definition (incidence of pancreatitis); exposure definition (new or current or past incretins users); and comparison between patients receiving incretins or not for type 2 diabetes. Two authors independently selected the studies and extracted the data. Six studies meeting the inclusion criteria were reviewed. No difference was found in the overall risk of pancreatitis between incretin users and non-users (odds ratio 1.08; 95 % CI [0.84-1.40]). A risk increase lower than 35 % cannot be excluded according to the power calculation. This systematic review and meta-analysis suggests that type 2 diabetes patients receiving incretin-based therapy are not exposed to an elevated risk of pancreatitis. Limitations of this analysis are the low prevalence of incretin users and the lack of a clear distinction by the studies between therapy with DPP-4 inhibitors or with GLP-1 receptor agonists.
authors.affiliation: Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy, giordaca@tin.it.
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Giorda
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Elisa
authors.initials: E
authors.lastname: Nada
authors.forename: Lisa
authors.initials: L
authors.lastname: Marafetti
authors.forename: Ileana
authors.initials: I
authors.lastname: Baldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gnavi
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D054795:Incretins / Q000009:adverse effects*; D064887:Observational Studies as Topic; D010195:Pancreatitis / Q000139:chemically induced*
chemical_list: D054795:Incretins