Use of incretin agents and risk of acute and chronic pancreatitis: A population-based cohort study

TY - JOUR

T1 - Use of incretin agents and risk of acute and chronic pancreatitis

T2 - A population-based cohort study

AU - Knapen, Lotte M.

AU - de Jong, Roy G P J

AU - Driessen, Johanna H M

AU - Keulemans, Yolande C.

AU - van Erp, Nielka P.

AU - De Bruin, Marie L.

AU - Leufkens, Hubert G M

AU - Croes, Sander

AU - de Vries, Frank

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Aim: To determine the association between the use of incretin agents (dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists) for the treatment of type 2 diabetes mellitus (T2DM) and the risk of any, acute and chronic pancreatitis. Research design and methods: A population-based cohort study was conducted using data from the UK Clinical Practice Research Datalink (CPRD 2007–2012). A total of 182 428 adult patients with ≥1 non-insulin antidiabetic drug (NIAD) prescription were matched to control subjects without diabetes. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of pancreatitis in incretin-users (N = 28 370) compared with controls and with other NIAD users. Adjustments were made for lifestyle, disease and drug history. In a sensitivity analysis, a new-user design was used. Results: Current incretin users had a 1.5-fold increased risk of any pancreatitis compared with NIAD users (adjusted HR 1.47, 95% CI 1.06–2.04). In incident current incretin users the risk of any and acute pancreatitis was increased 2.1- and 2.0-fold compared with NIAD users (adjusted HR 2.12, 95% CI 1.31–3.43 and adjusted HR 1.96, 95% CI 1.13–3.41), whereas there was no increased risk found for chronic pancreatitis. Conclusions: Incretin use was associated with an increased risk of any pancreatitis. Moreover, risk of any and acute pancreatitis was higher when applying a new-user design. We were not able to detect an association with chronic pancreatitis, but the number in this subgroup was small.

AB - Aim: To determine the association between the use of incretin agents (dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists) for the treatment of type 2 diabetes mellitus (T2DM) and the risk of any, acute and chronic pancreatitis. Research design and methods: A population-based cohort study was conducted using data from the UK Clinical Practice Research Datalink (CPRD 2007–2012). A total of 182 428 adult patients with ≥1 non-insulin antidiabetic drug (NIAD) prescription were matched to control subjects without diabetes. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of pancreatitis in incretin-users (N = 28 370) compared with controls and with other NIAD users. Adjustments were made for lifestyle, disease and drug history. In a sensitivity analysis, a new-user design was used. Results: Current incretin users had a 1.5-fold increased risk of any pancreatitis compared with NIAD users (adjusted HR 1.47, 95% CI 1.06–2.04). In incident current incretin users the risk of any and acute pancreatitis was increased 2.1- and 2.0-fold compared with NIAD users (adjusted HR 2.12, 95% CI 1.31–3.43 and adjusted HR 1.96, 95% CI 1.13–3.41), whereas there was no increased risk found for chronic pancreatitis. Conclusions: Incretin use was associated with an increased risk of any pancreatitis. Moreover, risk of any and acute pancreatitis was higher when applying a new-user design. We were not able to detect an association with chronic pancreatitis, but the number in this subgroup was small.

KW - acute pancreatitis

KW - chronic pancreatitis

KW - cohort studies

KW - dipeptidyl peptidase-4 inhibitors

KW - glucagon-like peptide-1 receptor agonists

KW - incretin-based therapy

KW - type 2 diabetes mellitus

U2 - 10.1111/dom.12833

DO - 10.1111/dom.12833

M3 - Journal article

C2 - 27883260

AN - SCOPUS:85012921293

SN - 1462-8902

VL - 19

SP - 401

EP - 411

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

IS - 3

ER -