Introduction & Objective: Glucagon-like peptide-1 receptor agonists (GLP1RA) may increase pancreatitis and biliary disease risk. We investigated the association between GLP1RA initiation and the risk of pancreatitis or biliary disease among patients with type 2 diabetes (T2D) at low-to-moderate cardiovascular (CV) risk, a population that remains largely unexplored in clinical trials.
Methods: We estimated hazard ratios (HRs), rate differences (RD) and 95% confidence intervals (CI) of acute pancreatitis or biliary disease among 1:1 propensity score-matched adults initiating GLP1RA vs. dipeptidyl peptidase-4 inhibitor (DPP4i) or sodium glucose cotransporter 2 inhibitor (SGLT2i) in Medicare and 2 private health plans (2013-2023).
Results: Over a mean follow-up of ~11 months, the HR for pancreatitis in the GLP1RA group was 1.19 (95%CI 1.00-1.42; RD 0.20 per 1,000 person-years (PY) [0.01-0.39]) compared with the DPP4i group and 0.99 (0.82-1.20; RD -0.01 per 1,000 PY [-0.17-0.16]) compared with the SGLT2i group (Table). The HR for biliary disease in the GLP1RA group was 1.10 (0.96-1.26; RD 0.13 per 1,000 PY [-0.10-0.37]) compared with the DPP4i group and 1.12 (0.97-1.30; RD 0.22 per 1,000 PY [0.01-0.43]) in the SGLT2i group.
Conclusion: GLP1RA initiation was not associated with meaningful differences in the risk of acute pancreatitis or biliary disease in patients with T2D and low-to-moderate CV risk.
J.M. Paik: None. H. Tesfaye: None. S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. E.O. DiCesare: None. C. Alix: None. D.J. Wexler: Other Relationship; Novo Nordisk. E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute.
Patient Centered Outcomes Research Institute (DB-2020C2-20326)
