GLP-1受体激动剂的起始和急性胰腺炎和胰腺癌的风险：一个真实世界的比较研究

American journal of medicine open Pub Date : 2025-08-20 DOI:10.1016/j.ajmo.2025.100114

Omar Faour MD , Moheb Boktor MD , Hanford Yau MD , Mustafa Kinaan MD , Ishak A Mansi MD

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引用次数: 0

摘要

胰高血糖素样肽1受体激动剂（GLP-1RA）药物因其对心脏-肾脏代谢的益处而广泛用于治疗2型糖尿病。然而，人们仍然担心它们与急性胰腺炎（AP）和胰腺癌的潜在关联。本研究的目的是研究GLP-1RAs与AP和胰腺癌风险的关系。方法本回顾性倾向评分匹配队列研究使用了退伍军人健康管理局2006 - 2021财政年度的国家数据。使用新用户活性比较剂设计，我们纳入了开始GLP-1RA或二肽基肽酶-4抑制剂（DPP-4i）药物治疗的退伍军人，后者作为活性比较剂。主要结局是AP和胰腺癌的发生。我们排除了有胰腺炎、胰腺肿瘤、胰腺先天性异常和饮酒史的患者。二次分析包括调整随访期间可能引入的混杂因素，如胆囊疾病，事后分析仅限于随访期间血清脂肪酶正常的人。结果共匹配了88,972对GLP-1RA和DPP-4i使用者的所有特征。214名DPP-4i使用者（0.24%）诊断为AP，而273名GLP-1RA使用者（0.31%）诊断为AP (OR 1.28; 95% CI, 1.09 -1.53)， 154名DPP-4i使用者（0.17%）诊断为胰腺癌，而211名GLP-1RA使用者（OR 1.37; 95% CI, 1.11-1.69）诊断为胰腺癌。二次分析和事后分析的结果与初步分析一致。结论与DPP-4i相比，glp - 1ras与AP和胰腺癌风险的适度但有统计学意义的增加相关。临床意义使用eglp - 1ra与急性胰腺炎和胰腺癌的优势比适度增加相关。尽管与文献中显示的益处相比，增加的风险似乎不大，但建议警惕，特别是当GLP-1RAs用于标签外适应症时。

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GLP-1 Receptor Agonists Initiation and Risk of Acute Pancreatitis and Pancreatic Cancer: A Real-World Comparative Study

Background

Glucagon-like peptide 1 receptor agonist (GLP-1RA) medications are widely used in managing type 2 diabetes because of their cardio-renal-metabolic benefits. However, concerns persist regarding their potential association with acute pancreatitis (AP) and pancreatic cancer. This study’s objective was to examine the association of GLP-1RAs with the risk of AP and pancreatic cancer.

Methods

This retrospective propensity score-matched cohort study used Veterans Health Administration national data during fiscal years 2006 to 2021. Using a new-user active comparator design, we included veterans who initiated either GLP-1RA or dipeptidyl peptidase-4 inhibitor (DPP-4i) medication, the latter as an active comparator. The primary outcomes were incident AP and pancreatic cancer. We excluded patients with a history of pancreatitis, pancreatic tumors, pancreatic congenital anomalies, and alcohol use. Secondary analysis included adjusting for confounders that may have been introduced during the follow-up period, such as gallbladder diseases, and post hoc analysis restricted analysis to people who had normal serum lipase during follow-up.

Results

We matched 88,972 pairs of GLP-1RA and DPP-4i users on all characteristics. AP was diagnosed in 214 (0.24%) DPP-4i users versus 273 (0.31%) GLP-1RA users (OR 1.28; 95% CI, 1.07-1.53), and pancreatic cancer was diagnosed in 154 (0.17%) DPP-4i users versus 211 (0.24%) GLP-1RA users (OR 1.37; 95% CI, 1.11-1.69). Secondary and post hoc analyses showed results consistent with the primary analysis.

Conclusions

GLP-1RAs are associated with a modest but statistically significant increase in the risk of AP and pancreatic cancer compared to DPP-4i.

Clinical significance

GLP-1RA use is associated with modestly increased odds ratio of acute pancreatitis and pancreatic cancer. Whereas the increased risk seems modest compared to their benefits as shown in the literature, vigilance is recommended, specifically, when GLP-1RAs are used for off label indications.

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来源期刊

American journal of medicine open Medicine and Dentistry (General)

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审稿时长

47 days