Are Incretin Therapies and Pancreatic Disease Linked?
FDA review finds no link between incretin therapies and the development of pancreatic disease among patients with diabetes
Commentary by Robert E. Ratner, MD and J. Michael Gonzalez-Campoy, MD, PhD, FACE
After reviewing the current literature on a possible link between incretin therapies and pancreatic disease, there is insufficient information to alter current treatment recommendations regarding these agents, according to a joint statement released by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the International Diabetes Federation (IDF).
“Over the last 2 month there has been an enormous amount of publicity and discussion about the role of incretin therapy and the potential for pancreatic complications,” explained Robert E. Ratner, MD, Chief Scientific and Medical Officer of the ADA. Thus, the three organizations wanted to provide guidance to primary care providers and other experts in diabetes care concerning the state of the literature and offer potential recommendations to patients, he said.
A Review of Current Findings
A panel convened by the National Institutes of Health in June 2013 found that diabetes was an independent risk factor for pancreatic carcinoma and was linked to an approximately 82% increased risk of malignancy, the organizations noted in the statement. In addition, no concern for pancreatic disease was found in a US Food and Drug Administration review of preclinical pathology from all currently available incretin therapies as well as agents in development. Furthermore, while a recent human autopsy study also suggested a possible risk for pancreatic disease, this study had significant limitations.
Regulatory and clinical trials all suggest that incretin therapies are more effective than placebo for improving glucose control and achieving weight loss, and are at least equivalent, if not superior, to other agents such sulphonylureas, thiazolidinediones, and long-acting insulin therapies, according to the statement.
In light of coverage of the potential for pancreatic disease in the lay press, “We certainly don’t want patients to stop taking medications without consulting their health care providers,” Dr. Ratner said. It is also important for patients to tell their health care providers “whether the medications they are on are helping or are having any side effects or complications, and then to undergo a shared decision-making process to decide what the best therapy might be for them,” Dr. Ratner said.
First, Do No Harm
"The ADA/EASD/IDF statement on incretin therapy and pancreatic disease is welcome, commented J. Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO, Minnesota Center for Obesity, Metabolism and Endocrinology, Eagan, Minnesota. “It reminds us that in the practice of medicine we must emphasize the benefit of treating diseases, and pause considerably before giving any attention to associations,” he told DiabeticLifestyle.com.
“There is a strong association between diabetes and pancreas cancer,” Dr. Gonzalez-Campoy noted. “There are also strong associations between diabetes and obesity, gallbladder disease, and pancreatitis. It is not surprising that any treatment for diabetes is also associated with pancreas cancer or pancreatitis,” he said.
“It is important for the medical community to first do no harm, and to ensure patient safety,” Dr. Gonzalez-Campoy said. “Associations between medication use and observations made in individual patients, or small groups of patients, seldom accomplish this. To the contrary, when these associations are given undue attention in the lay media, patients hesitate to take safe and effective treatments for their disease. Undoubtedly, untreated diseases cause much more harm to patients,” he concluded.