Tobacco use, type 2 diabetes top risk factors for pancreatitis with obesity treatment
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CHARLOTTE, N.C. — Tobacco use, type 2 diabetes and advanced chronic kidney disease increased the risk for acute pancreatitis after initiation of glucagon-like peptide-1 receptor agonists for weight loss, noted a presenter at the ACG Annual Scientific Meeting.
However, a BMI of 36 kg/m2 or more had a protective effect against acute pancreatitis.
“GLP-1RAs are effective and safe medications for the treatment of obesity. Despite the small risk of acute pancreatitis, they should still be used to treat obesity and comorbidities, like type 2 diabetes mellitus. However, as with all medications, the prescriber needs to be aware of the risks and benefits,” Robert Postlethwaite, MD, a third-year resident in internal medicine at the University of Texas Southwestern and co-author of the study, told Healio.
“When prescribing GLP-1RAs for weight loss, providers need to look at the patient’s comorbidities to stratify their risks of treatment,” he said. “We can aim to prevent the development of acute pancreatitis in high-risk individuals or at the least be more aware of its risk and be able to identify it early enough to stop the GLP-1RA and prevent complications.”
Postlethwaite and colleagues conducted a retrospective, single-center study to identify patient factors that impact the risk for acute pancreatitis after initiation of GLP-1RAs for obesity.
“With the increasing use of the GLP-1 receptor agonists in the United States for treating obesity and type 2 diabetes, more research was needed to evaluate factors that may predispose patients to rare but serious adverse effects of treatment,” Postlethwaite said. “Depending on the severity of acute pancreatitis, the mortality rate can be as high as 50%; however, the overall mortality rate is closer to 5%. Therefore, it was important to determine which patients may be at risk of developing acute pancreatitis after being started on a GLP-1RA for weight loss.”
The study included 2,245 patients (mean age, 49.5 years; 80.5% women) who participated in a wellness program at an academic institution between Jan. 1, 2015, and Dec. 31, 2021. Patients had an average BMI of 39.7 kg/m2.
According to results, 49 patients (2.2%) developed acute pancreatitis following initiation of GLP-1RA treatment. “Notably, we excluded episodes of pancreatitis that were caused by an obvious alternative etiology, such as gallstones or alcohol use,” Postlethwaite said.
Researchers reported that a history of type 2 diabetes mellitus, tobacco use and chronic kidney disease stage 3 or higher were linked with an increased risk of acute pancreatitis, with adjusted odds ratios of 2, 3.3 and 2.3, respectively.
However, BMIs of 36 kg/m2 to 40 kg/m2 and greater than 40 kg/m2 were associated with lower risk for acute pancreatitis compared with a BMI of 30 kg/m2 or less, with aORs of 0.22 and 0.27, respectively.
According to Postlethwaite, the most common adverse events associated with GLP-1RAs include nausea, vomiting, diarrhea and constipation. It is important, he noted, for gastroenterologists to differentiate these events from alternative etiologies, including acute pancreatitis.
“Many gastroenterologists treat patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Given the lack of effective treatments for NAFLD and that the majority of these patients have obesity and type 2 diabetes mellitus, GLP-1RA therapy is appropriate,” Postlethwaite said. “Therefore, our specialty may be prescribing more GLP-1RAs in the future, and it is important to educate our colleagues how to mitigate the risk of potential adverse outcomes, like acute pancreatitis.”
He added, “A prior history of acute pancreatitis, alcohol use and gallstone disease was not associated with an increased risk of acute pancreatitis in people who were prescribed GLP-1RA for treating obesity. Therefore, providers may not need to withhold GLP-1RA therapies in these groups as patients will likely benefit from obesity treatment and less than 2% of eligible people receive anti-obesity medications in the U.S.”
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Postlethwaite R, et al. Abstract S1443: Predictors of pancreatitis on initiation of GLP-1 receptor agonists for weight loss. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid).
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