Advertisement
Research Article| Volume 98, ISSUE 2, P271-284, November 2012

A meta-analysis of serious adverse events reported with exenatide and liraglutide: Acute pancreatitis and cancer

  • Carlos Alves
    Correspondence
    Corresponding author at: Health Technology Assessment (HTA) Centre, AIBILI – Association for Innovation and Biomedical Research on Light and Image, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal. Tel.: +351 239 480 100; fax: +351 239 480 117.
    Affiliations
    Health Technology Assessment (HTA) Centre, AIBILI, Coimbra, Portugal

    School of Pharmacy, University of Coimbra, Coimbra, Portugal

    CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
    Search for articles by this author
  • Francisco Batel-Marques
    Affiliations
    Health Technology Assessment (HTA) Centre, AIBILI, Coimbra, Portugal

    School of Pharmacy, University of Coimbra, Coimbra, Portugal
    Search for articles by this author
  • Ana F. Macedo
    Affiliations
    CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
    Search for articles by this author
Published:September 25, 2012DOI:https://doi.org/10.1016/j.diabres.2012.09.008

      Abstract

      Aims

      The association between GLP-1 agonists, acute pancreatitis (AP), any cancer and thyroid cancer is discussed. This meta-analysis was aimed at evaluating the risk of those serious adverse events associated with GLP-1 agonists in patients with type 2 diabetes.

      Methods

      Medline, EMBASE, Cochrane Library and clinicaltrials.gov were searched in order to identify longitudinal studies evaluating exenatide or liraglutide use and reporting data on AP or cancer. Odds ratios (ORs) were pooled using a random-effects model. I2 statistics assessed heterogeneity.

      Results

      Twenty-five studies were included. Neither exenatide (OR 0.84 [95% CI 0.58–1.22], I2 = 30%) nor liraglutide (OR 0.97 [95% CI 0.21–4.39], I2 = 0%) were associated with an increased risk of AP, independent of baseline comparator. The pooled OR for cancer associated with exenatide was 0.86 (95% CI 0.29, 2.60, I2 = 0%) and for liraglutide was 1.35 (95% CI 0.70, 2.59, I2 = 0%). Liraglutide was not associated with an increased risk for thyroid cancer (OR 1.54 [95% CI 0.40–6.02], I2 = 0%). For exenatide, no thyroid malignancies were reported.

      Conclusions

      Current available published evidence is insufficient to support an increased risk of AP or cancer associated with GLP-1 agonists. These rare and long-term adverse events deserve properly monitoring in future studies evaluating GLP-1 agonists.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nathan D.M.
        • Buse J.B.
        • Davidson M.B.
        • Ferrannini E.
        • Holman R.R.
        • Sherwin R.
        • et al.
        Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes.
        Diabetes Care. 2009; 32: 193-203
        • Drucker D.J.
        • Buse J.B.
        • Taylor K.
        • Kendall D.M.
        • Trautmann M.
        • Zhuang D.
        • et al.
        Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study.
        Lancet. 2008; 372: 1240-1250
        • Madsbad S.
        • Schmitz O.
        • Ranstam J.
        • Jakobsen G.
        • Matthews D.R.
        NN2211-1310 International Study Group Improved glycemic control with no weight increase in patients with type 2 diabetes after once-daily treatment with the long-acting glucagon-like peptide 1 analog liraglutide (NN221): a 12-week, double-blind, randomized, controlled trial.
        Diabetes Care. 2004; 27: 1334-1342
      1. Byetta drug approval package. FDA/Centre for Drug Evaluation and Research, available at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2005/021773_ByettaTOC.cfm; 2005 [access2nd edn3.05.12].

      2. European public assessment report (EPAR) for Byetta. EMA/Committee for Medicinal Products for Human Use, available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000698/human_med_000682.jsp&mid=WC0b01ac058001d124; 2006 [access2nd edn3.05.12].

      3. Bydureon label and approval history. FDA/Centre for Drug Evaluation and Research, available at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#apphist; 2012 [access2nd edn3.05.12].

      4. European public assessment report (EPAR) for Bydureon. EMA/Committee for Medicinal Products for Human Use, available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002000/human_med_001457.jsp&mid=WC0b01ac058001d124; 2011 [accessed 23.05.12].

      5. Victoza approval package. FDA/Centre for Drug Evaluation and Research, available at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2010/022341s000TOC.cfm; 2010 [accessed 23.05.12].

      6. European public assessment report (EPAR) for Victoza. EMA/Committee for Medicinal Products for Human Use, available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001026/human_med_001137.jsp&mid=WC0b01ac058001d124; 2009 [accessed 23.05.12].

        • Drucker D.J.
        • Sherman S.I.
        • Gorelick F.S.
        • Bergenstal R.M.
        • Sherwin R.S.
        • Buse J.B.
        Increatin-based therapies for the treatment of type 2 diabetes: evaluation of the risks and benefits.
        Diabetes Care. 2010; 33: 428-433
      7. FDA alert: information for healthcare professionals: exenatide (marketed as Byetta). FDA/Postmarket Drug Safety Information for Patients and Providers, available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124713.htm; 2007 [accessed 23.05.12].

        • Elashoff M.
        • Matveyenko A.V.
        • Gier B.
        • Elashoff R.
        • Butler P.C.
        Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies.
        Gastroenterology. 2011; 141: 150-156
        • Raschi E.
        • Piccinni C.
        • Poluzzi E.
        • Marchesini G.
        • De Ponti F.
        The association of pancreatitis with antidiabetic drug use: gaining insight through the FDA pharmacovigilance database.
        Acta Diabetol. 2011; ([published online 19 October; http://dx.doi.org/10.1007/s00592-011-0340-7])
        • Dore D.D.
        • Seeger J.D.
        • Chan K.A.
        Use of a claims-based active drug safety surveillance system to assess the risk of acute pancreatitis with exenatide or sitagliptin compared to metformin or glyburide.
        Curr Med Res Opin. 2009; 25: 1019-1027
        • Garg R.
        • Chen W.
        • Pendergrass M.
        Acute pancreatitis in type 2 diabetes treated with exenatide or sitagliptin: a retrospective observational pharmacy claims analysis.
        Diabetes Care. 2010; 33: 2349-2354
        • Dore D.D.
        • Bloomgren G.L.
        • Wenten M.
        • Hoffman C.
        • Clifford C.R.
        • Quinn S.G.
        • et al.
        A cohort study of acute pancreatitis in relation to exenatide use.
        Diabetes Obes Metab. 2011; 13: 559-566
      8. Byetta (exenatide) injection-detailed view: safety labelling changes approved by FDA Centre for Drug Evaluation and Research. FDA/MedWatch the FDA Safety Information and Adverse Event Reporting Program, available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm190571.htm; 2009 [accessed 23.05.12].

        • Parks M.
        • Rosenbraugh C.
        Weighting risks and benefits of liraglutide – the FDA's review of a new antidiabetic therapy.
        N Engl J Med. 2010; 362: 774-777
        • Bjerre Knudsen L.
        • Madsen L.W.
        • Andersen S.
        • Almholt K.
        • de Boer A.S.
        • Drucker D.J.
        • et al.
        Glucagon-like peptide-1 receptor agonists active rodent thyroid C-cells causing calcitonin release and C-cell proliferation.
        Endocrinology. 2010; 151: 1473-1486
      9. MSSO medical dictionary for regulatory activities. MedDRA v14.0, available at: http://www.meddramsso.com/index.asp [accessed 23.04.12].

        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for assessment of the methodological quality of both the randomised and nonrandomised studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analysis.
        BMJ. 2003; 327: 557-560
        • Publication bias.
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.T.
        • Rothstein H.R.
        Introduction to meta-analysis.
        John Wiley & Sons, Chichester, England2009
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Balani A.R.
        • Grendell J.H.
        Drug-induced pancreatitis: incidence, management, and prevention.
        Drug Saf. 2008; 31: 823-837
        • Noel R.A.
        • Braun D.K.
        • Patterson R.E.
        • Bloomgren G.L.
        Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes.
        Diabetes Care. 2009; 32: 834-838
        • Anderson S.L.
        • Trujillo M.J.
        Association of pancreatitis with glucagon-like peptide-1 agonist use.
        Ann Pharmacother. 2010; 44: 904-909
      10. MedWatch. Victoza (liraglutide [rDNA origin]) Injection: REMS – risk of thyroid C-cell tumors, Acute Pancreatitis. FDA/MedWatch the FDA Safety Information and Adverse Event Reporting Program, available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258826.htm, 2011 [accessed 23.05.12].

        • Butler P.C.
        • Dry S.
        • Elashoff R.
        GLP-1-based therapy for diabetes: what you do not know can hurt you.
        Diabetes Care. 2010; 33: 453-455
        • Butler A.E.
        • Galasso R.
        • Matveyenko A.V.
        • Rizza R.A.
        • Dry S.
        • Butler P.C.
        Pancreatic duct replication is increased with obesity and type 2 diabetes in humans.
        Diabetologia. 2010; 53: 21-26
        • Koehler J.A.
        • Baggio L.L.
        • Lamont B.J.
        • Ali S.
        • Drucker D.J.
        Glucagon-like peptide-1 receptor activation modulates pancreatitis-associated gene expression but does not modify the susceptibility to experimental pancreatitis in mice.
        Diabetes. 2009; 58: 2148-2161
        • Nachnani J.S.
        • Bulchandani D.G.
        • Nookala A.
        • Herndon B.
        • Molteni A.
        • Pandya P.
        • et al.
        Biochemical and histological effects of exendin-4 (exenatide) on the rat pancreas.
        Diabetologia. 2010; 53: 153-159
        • Vrang N.
        • Jelsing J.
        • Simonsen L.
        • Jensen A.E.
        • Thorup I.
        • Søeborg H.
        • et al.
        The effects of 13 weeks of liraglutide treatment on endocrine and exocrine pancreas in male and female ZDF-rats: no evidence of drug induced pancreatitis.
        Am J Physiol Endocrinol Metab. 2012; ([published online 15 May, http://dx.doi.org/10.1152/ajpendo.00182.2012])
        • Jüni P.
        • Witschi A.
        • Bloch R.
        • Egger M.
        The hazards of scoring the quality of clinical trials for meta-analysis.
        JAMA. 1999; 282: 1054-1060
      11. Parola T. Victoza® (liraglutide injection): human relevance of rodent thyroid C-cell tumors. FDA/Endocrinologic and Metabolic Drugs Advisory Committee Meeting, available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM151129.pdf; 2009 [accessed 23.05.12].

        • DeFronzo R.A.
        • Ratner R.E.
        • Han J.
        • Kim D.D.
        • Fineman M.S.
        • Baron A.D.
        Effects of exenatide (Exendin-4) on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes.
        Diabetes Care. 2005; 28: 1092-1100
        • Kendall D.M.
        • Riddle M.C.
        • Rosenstock J.
        • Zhuang D.
        • Kim D.D.
        • Fineman M.S.
        • et al.
        Effects of exenatide (Exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and sulfonylurea.
        Diabetes Care. 2005; 28: 1083-1091
        • Buse J.B.
        • Henry R.R.
        • Han J.
        • Kim D.D.
        • Fineman M.S.
        • Baron A.
        • et al.
        Effects of exenatide (Exendin-4) on glycemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes.
        Diabetes Care. 2004; 27: 2628-2635