title: Are incretin mimetics and enhancers linked to pancreatitis and malignant transformations in pancreas?
abstract: BACKGROUND
  Dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists are new options in the treatment of type 2 diabetes mellitus. However, due to accumulating reports on the occurrence of acute pancreatitis (AP), a suspicion of an association between incretin-based therapies and pancreatic disease has arisen.
  
  
  METHODS
  A review of the literature on the safety of incretin-based therapies in regard to AP and pancreatic cancer was undertaken with discussion of potential mechanisms as well as limitations.
  
  
  CONCLUSIONS
  Until now, several preclinical and clinical studies have been published; however, they present conflicting results. Common risk factors, low incidence rates, long latency periods (in regard to pancreatic malignancy), lack of availability of human pancreatic tissues during lifetime among others hamper the confirmation or exclusion of a causal association. The results of the ongoing large randomized controlled trials will add further data. In line with current recommendations by European Medicines Agency and FDA, incretin-based therapies should be discontinued in patients with suspicion of AP, and incretin mimetics should not be administered to patients with a history of AP. However, based on current knowledge, there is no sound reason for depriving type 2 diabetic patients in general of a beneficial and effective therapy. However, this conclusion cannot be final and should be subject to constant reevaluation and, if necessary, change.
authors.affiliation: Ludwig-Maximilians-University Munich Campus Grosshadern, Department of Internal Medicine II , Marchinoninistr. 15, 81377 Munich , Germany +49 89 7095 2391 ; burkhard.goeke@med.uni-muenchen.de.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: de Heer
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002471:Cell Transformation, Neoplastic / Q000139:chemically induced*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000201:enzymology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D000067757:Glucagon-Like Peptide-1 Receptor; D006801:Humans; D054795:Incretins / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000139:chemically induced* / Q000175:diagnosis; D010195:Pancreatitis / Q000139:chemically induced* / Q000175:diagnosis; D018027:Receptors, Glucagon / Q000819:agonists / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; C000593833:GLP1R protein, human; D000067757:Glucagon-Like Peptide-1 Receptor; D054795:Incretins; D018027:Receptors, Glucagon
keywords: dipeptidyl peptidase-4 inhibitor; gliptins; glucagon-like peptide-1; insulin; obesity; pancreatic cancer; pancreatitis; type 2 diabetes mellitus