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Sitagliptin, liraglutide alter pancreatic enzyme concentrations
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Patients with type 2 diabetes experienced a brief and modest increase of plasma pancreatic enzyme concentrations after 12 weeks of treatment with sitagliptin or liraglutide compared with placebo, study data show.
Mark M. Smits, MD, of the Diabetes Center at VU University Medical Center in Amsterdam, and colleagues evaluated 55 adults with type 2 diabetes randomly assigned to the GLP-1 receptor agonist liraglutide (Victoza, Novo Nordisk) 1.8 mg (n = 19), the DPP-IV inhibitor sitagliptin (Januvia, Merck) 100 mg (n = 19) or placebo (n = 17) once daily for 12 weeks to determine the effect of each therapy on pancreatic physiology and morphology.
After 12 weeks, there were no signs of pancreatitis on MRI. Liraglutide did not significantly alter pancreatic steatosis, whereas it was reduced by sitagliptin (P = .04). Pancreatic volume was modestly increased with liraglutide (P = .09) and sitagliptin (P = .12).
Total secreted pancreatic fluid volume was increased with sitagliptin (P = .05); researchers observed no effect with liraglutide.
Compared with placebo, lipase concentrations were higher with liraglutide (P = .03) at 6 weeks. No differences were found among the three groups for changes in plasma amylase concentrations. However, at 6 weeks, amylase tended to be higher with liraglutide (P = .06), and at 2 weeks (P = .03) and 6 weeks (P = .01), amylase was higher with sitagliptin compared with placebo. Both treatments resulted in higher plasma trypsinogen concentrations compared with placebo (liraglutide, P = .001; sitagliptin, P = .01).
“In this comprehensive study of patients with type 2 diabetes, treatment with a GLP-1 receptor agonist or DPP-IV inhibitor increase serum trypsinogen concentrations after 12 weeks, but not lipase of amylase concentrations,” the researchers wrote. “Furthermore, our study suggests an association between treatment-induced changes in plasma enzyme concentrations and pancreatic volume expansion. Pancreatic exocrine function was unaffected, with the exception of exocrine fluid secretion, which was stimulated by sitagliptin. It seems unlikely that these subtle changes will induce pancreatitis after long-term treatment, but this requires further study.” – by Amber Cox
Disclosure: Smits reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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