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Comparative Study
. 2014 Apr 24:348:g2780.
doi: 10.1136/bmj.g2780.

Incretin based drugs and risk of acute pancreatitis in patients with type 2 diabetes: cohort study

Jean-Luc Faillie  1 , Laurent Azoulay, Valerie Patenaude, Dominique Hillaire-Buys, Samy Suissa
Affiliations
Comparative Study

Incretin based drugs and risk of acute pancreatitis in patients with type 2 diabetes: cohort study

Jean-Luc Faillie et al. BMJ. .

Abstract

Objectives: To determine whether the use of incretin based drugs, compared with sulfonylureas, is associated with an increased risk of acute pancreatitis.

Design: Population based cohort study.

Setting: 680 general practices in the United Kingdom contributing to the Clinical Practice Research Datalink.

Participants: From 1 January 2007 to 31 March 2012, 20 748 new users of incretin based drugs were compared with 51 712 users of sulfonylureas and followed up until 31 March 2013.

Main outcome measures: Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for acute pancreatitis in users of incretin based drugs compared with users of sulfonylureas. Models were adjusted for tenths of high dimensional propensity score (hdPS).

Results: The crude incidence rate for acute pancreatitis was 1.45 per 1000 patients per year (95% confidence interval 0.99 to 2.11) for incretin based drug users and 1.47 (1.23 to 1.76) for sulfonylurea users. The rate of acute pancreatitis associated with the use of incretin based drugs was not increased (hdPS adjusted hazard ratio: 1.00, 95% confidence interval 0.59 to 1.70) relative to sulfonylurea use.

Conclusions: Compared with use of sulfonylureas, the use of incretin based drugs is not associated with an increased risk of acute pancreatitis. While this study is reassuring, it does not preclude a modest increased risk, and thus additional studies are needed to confirm these findings.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: database acquisitions were funded by the Canadian Institute of Health Research (CIHR) and the Canada Foundation for Innovation; SS has received research grants, participated in advisory board meetings and/or as a speaker at conferences for AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers-Squibb, Merck, and Novartis, all of which except Bayer are manufacturers of incretin based drugs, though none of these activities were related to diabetes or incretins, with the exception of a single participation in a mock advisory panel for Bristol-Myers-Squibb.

Figures

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Fig 1 Flow of participants in cohort study of effect of incretin based drugs in patients with type 2 diabetes
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Fig 2 Kaplan-Meier curves for acute pancreatitis in users of incretins compared with users of sulfonylurea (log rank P=0.36)
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