Gastroenterology

Gastroenterology

Volume 141, Issue 1, July 2011, Pages 20-23
Gastroenterology

Editorial
GLP-1–Based Therapies: The Dilemma of Uncertainty

https://doi.org/10.1053/j.gastro.2011.05.019Get rights and content

Section snippets

Risk of Pancreatitis

Acute pancreatitis accompanying exenatide was first reported in 2006.3 The FDA drew attention to a potential pancreatitis risk associated with sitagliptin in 2009.4 Existing human studies on pancreatitis and incretin-based therapy are conflicting. Two recent analyses involving either exenatide or sitagliptin treatment compared these treatments with other anti-diabetic drug regimen. No relationship between GLP-1 therapy and pancreatitis was reported.5, 6 Notably, Amylin Pharmaceuticals sponsored

Risk of Pancreatic Cancer

Besides an unexpectedly high number of pancreatitis, Elashoff et al report on pancreatic cancer in patients having been treated with exenatide or sitagliptin. Although no clinical study has been performed addressing this issue, the results are in line with a recent analysis of spontaneous reports from Germany performed by the Drug Commission of the German Medical Association. In the German database 11 reports of pancreatic cancer in association with exenatide were identified,12 which was an

Risk of Thyroid Cancer

Liraglutide was associated with medullary thyroid cancer in rodents.17 Despite those findings, liraglutide was approved considering data that suggested a non-genotoxic mechanism and also indicated that the GLP-1R expression in rodent thyroid C cells is higher than in human cells. Marketing approval was given, and linked to specific postmarketing surveillance activities to address this question. The link between exenatide and thyroid cancer presented by Elashoff et al raises some concern.

Acknowledgment

The authors thank Friedrich Luft for his thoughtful comments.

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Conflict of interest The authors disclose the following: Joachim Spranger has lectured for or received consultant honorary from Eli Lilly, NovoNordisk, Berlin Chemie, Merck-Sharp & Dohme, Bristol-Myers Squibb, Novartis, Takeda, GlaxoSmithKline and Sanofi-Aventis. The remaining authors disclose no conflicts.

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