Diabetes Drug May Raise Pancreatitis Risk

Two common medications, including one used to treat diabetes, may increase your risk of developing pancreatitis, according to two new studies.

By Amir Khan, Everyday Health Staff Writer

MONDAY, Feb. 25, 2013 — Pancreatitis is the inflammation of the pancreas, and occurs when enzymes that digest food activate in the pancreas instead of the small intestine. While majority of the cases occur from excessive alcohol consumption or gallstones, two new studies have linked two common medications to the disease, which researchers say may help explain pancreatitis often appears without any cause.

Cortisone, a hormone used to treat a number of diseases from psoriasis to arthritis, may increase your risk for pancreatitis, the study found. Patients taking it were 70 percent more likely to develop acute pancreatitis, which, while treatable, can cause long-lasting and severe problems. Excessive alcohol consumption and gallstones are the primary causes of pancreatitis, but the cause of 20 percent of pancreatitis cases is unknown — and researchers say cortisone may play a role in how those cases develop.

“Drug-induced acute pancreatitis has previously been considered as a rare cause of acute pancreatitis,” the researchers, led by Omid Sadr-Azodi, MD, study author and assistant physician at Eskilstuna County Hospital in Sweden, wrote in the study, “but recent reports have indicated that drug induced acute pancreatitis might be the third most common cause of the disease, accounting for 3 to 5 percent of all cases.”

 Researchers looked at 6,000 patients diagnosed with pancreatitis between 2006 and 2008 and compared them to 61,000 healthy people, finding that people who were treated with medicine containing cortisone, such as Prednisolone, were 70 percent more likely to develop pancreatitis. The pancreatitis risk was higher in patients who smoked tobacco and drank alcohol, leading researchers to advise patients to avoid those substances while taking medications containing cortisone. The findings were published today in the journal JAMA Internal Medicine.

“There was no observable increase in risk for people who used aerosol cortisone, such as asthma inhalers," Dr. Sadr-Azodi MD said in a statement. “But people who start a course of cortisone are recommended to refrain from drinking and smoking, which are risk factors for acute pancreatitis."

A second study found that a new class of diabetes drugs, known as glucagon-like peptide-1-based therapies (GLP-1) and sold under brand names like Januvia and Byetta, can also cause pancreatitis, and according to the study, also published in JAMA Internal Medicine, patients on GLP-1 therapies are twice as likely to end up hospitalized for pancreatitis.

“We were surprised by the large risk increase,” says Sonal Singh, M.D., study author and assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. “Pancreatitis is a debilitating condition, and our message is that you need to be alert for the symptoms if you’re taking these drugs.”

Symptoms of pancreatitis include abdominal pain, nausea, vomiting and tenderness in the abdomen. Pancreatitis usually resolves in a few days, and treatment typically consists of morphine to control the pain, oxygen to help restore normal lung function and fluids to avoid dehydration. However, severe cases can lead to cancer or result in death, and Singh says more research needs to be conducted on these drugs to better understand the risks.

“Pancreatitis is a marker for pancreatic cancer, so that’s one of the biggest concerns,” he says. “We don’t have enough information over the long term to know if these therapies can lead to it.”

But, Howard Weintraub, MD, a clinical associate professor in the department of medicine at the Leon H. Charney Division of Cardiology at NYU Langone Medical Center in New York says that GLP-1 therapies are able to treat diabetes without many of the side effects that come with insulin, such as weight gain and cardiovascular effects, which makes it the prime choice for diabetics, despite the pancreatitis risk.

“Cardiologists have taken to liking GLP-1 because other [diabetes] drugs can cause heart issues,” Dr. Weintraub says. “These drugs can help diabetics without causing those issues.”

Weintraub says he’s not disputing the study findings, but instead saying that the pancreatitis risk may be worth it.

“I’m not debating the fact that there’s an uptick in pancreatitis,” he says, “but I’ll tolerate a little pancreatic irritation for not putting someone into heart failure.”

However, Weintraub admitted that the GLP-1 therapies may not be for everyone.

“I think the bottom line is that there needs to be vigilance, attention and focus on potential side effects,” he says. “Patients should be carefully selected to be the drugs.”