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European drugs agency clashes with scientists over safety of GLP-1 drugs

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4838 (Published 30 July 2013) Cite this as: BMJ 2013;347:f4838

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Re: European drugs agency clashes with scientists over safety of GLP-1 drugs

Dear sirs,

Recently Dr. Cohen discussed the potential adverse pancreatic effects of glucagon-like peptide-1 (GLP-1) agonists and dipeptidylpeptidase-4 (DPP-4) inhibitors ( BMJ. 2013 Jun 7;346:f3680. doi: 10.1136/bmj.f3680.).

Many practicing diabetologists have encountered mild asymptomatic amylase elevations in patients started on these drugs. After stopping the incretin therapy the amylase elevation usually regresses. As clinically frank overt pancreatitis rarely develops, these observations seldom find their way into the adverse event reporting system.

Based on pathophysiological considerations and experimental data incretin therapies may have the potential to induce cell growth and proliferation in the Langerhans-islets, but whether this can lead to an improvement of ß-cell function or to the development of chronic pancreatitis or pancreatic cancer (or neither) is yet to be seen.

It may be reasonable to include the measurement of serum amylase levels in the follow-up of patients started on incretin therapies for some months – and to report all observed elevations.

Yours sincerely

Z. Lengyel MD, PhD

Szent Margit Hospital, 4th Dpt.of Internal Medicine, Budapest

Competing interests: No competing interests

12 August 2013
Zoltán Lengyel
Diabetologist
Szent Margit Kórház, 4th Dpt. of Internal Medicine
1032, Budapest, Bécsi út 132. Hungary