Incretin-based drugs and the risk of pancreatitis (Q13-06A)

Incretin-based drugs and the risk of pancreatitis (Q13-06A)

Q13-06A

Overview

What is the issue
  • Incretin-based drugs are second or third-line therapies used to treat type 2 diabetes. While they are widely used, there are concerns that they may increase the risk of pancreatitis.
What was the aim of the study?
  • This study, examined whether incretin-based drugs are associated with an increased risk for acute pancreatitis, as compared with the use of two or more oral antidiabetic drugs.
How was the study conducted?
  • Our investigators conducted seven population-based cohort studies and a meta-analysis with the health records of 1,532,513 patients from five Canadian provinces and two international databases. Cohorts of first-ever users of oral antidiabetic drugs were constructed at each site.
  • Nested case-control analyses were performed in each cohort to compare the incidence of hospitalizations for acute pancreatitis among current users of incretin-based drugs to those who currently use two or more oral antidiabetic drugs.
  • Several secondary analyses were conducted to assess whether the risk varied by class of drug or duration of use.
What did the study find?
  • This study found that patients using incretin-based drugs were not at an increased risk of hospitalization for acute pancreatitis, compared to patients using two or more other oral antidiabetic drugs. Furthermore, the risk did not vary by drug class or duration.
  • These findings should provide some reassurance to patients treated with incretin-based drugs.
  • We have the ability to analyze a large amount of anonymous patient data to reliably assess questions of drug safety and effectiveness. The present study is the largest population-based study on this topic and supports the findings of numerous other observational studies before it.
Implications
  • The findings of this study should provide some reassurance that the use of incretin-based drugs is not associated with an increased risk of acute pancreatitis.
Key message
  • The use of incretin-based drugs is not associated with an overall increased risk of pancreatitis, compared with other oral antidiabetic drugs.

Manuscripts

Secrest M, Udell JA, Filion KB. The cardiovascular safety trials of DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors. Trends Cardiovasc Med 2017 Apr;27(3):194-202.

Filion KB, Suissa S. DPP-4 inhibitors and heart failure: Some reassurance, some uncertainty. Diabetes Care 2016 May; 39(5):735–737. [Invited Commentary].

Azoulay L, Filion B, Platt R, Dahl M, Dormuth C, Clemens K, Durand M, Hu N, Juurlink D, Paterson M, Targownik L, Turin T, Ernst P, CNODES Investigators. Association Between Incretin-Based Drugs and the Risk of Acute Pancreatitis. JAMA Intern Med. 2016 Oct 1;176(10):1464-1473.

Azoulay L, Filion KB, Platt R, Dahl M, Dormuth C, Clemens K, Durand M, Juurlink DN, Targownik L, Turin T, Paterson M, Ernst P; CNODES Investigators. Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study. BMJ. 2016 Feb 17;352:i581.

Filion KB, Azoulay L, Platt R, Dahl M, Dormuth C, Clemens K, Hu N, Paterson M, Targownik L, Turin T, Udell J, Ernst P; CNODES Investigators. A Multicenter Observational Study of Incretin-based Drugs and Heart Failure. N Engl J Med. 2016 Mar 24;374(12):1145-54.

Presentations

Project Team

Project Co-Lead
Pierre Ernst MD, MSc, FRCPC
Project Co-Lead
Laurent Azoulay PhD
Methods Lead
Robert W. Platt PhD
Content Expert
Kristin Clemens
Lead Analyst
Matthew Dahl BSc
Site Investigator
Nianping Hu PhD
Saskatchewan
Site Investigator
Laura Targownik
Manitoba
Site Investigator
Kristian Filion PhD
CPRD
Site Investigator
Madeleine Durand MD, MSc, FRCPC
Quebec
Site Investigator
David Juurlink
Ontario
Site Investigator
Colin R. Dormuth ScD
MarketScan
Site Investigator
Tanvir Chowdhury Turin PhD
Alberta
Analyst
Shan Jin MSc
Saskatchewan
Analyst
Menglan Pang MSc
Quebec
Analyst
Simon Hollands MSc
Ontario
Analyst
Ontario
Analyst
Greg Carney BSc, PhD
MarketScan
Analyst
Manitoba
Analyst
Zhihai Ma
Alberta
Analyst
Jianguo (James) Zhang MSc
Alberta