Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort studyBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i581 (Published 17 February 2016) Cite this as: BMJ 2016;352:i581
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The authors investigated the risk of pancreatic cancer associated with incretin-based drugs. They should point out the high incidence and prevalence of acute and chronic pancreatitis (acute about 30 per 100.000 people/year) with severe complications and mortality rates between 2-9%. In 2013 pancreatitis resulted in 123.000 deaths up from 83.000 deaths in 1990 . Drug induced pancreatitis may be rare (incidence to 2% ).
One of the most common cause is severe alcohol abuse. But the World Health Organization (WHO) database listed 525 different drugs which possible can induce a pancreatitis as an adverse reaction . The most common drugs were steroids, diuretics, estrogens, chemotherapeutic, antihyperglycemic and choleseterol-lowering drugs like statins. But it is important to emphasize the risk of a pancreatitis associated with atypycal antipsychotics and with valproic acid. According to the Food and Drug Administration's MedWatch Surveillance System atypical antipsychotics such as clozapine can induce pancreatitis . The authors identified 192 cases of pancreatitis, 72 cases were associated with clozapine, 62 with olanzapine (monotherapy). In a drug surveillance Project, 25 patients were diagnosed with pancreatitis (of a total of 365.062 observed psychiatric inpatients). The most common drugs were clozapine (18 cases, incidence: 0,06%), valproic acid (incidence:: 0.012%) and mirtazapine.
1) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 385: 117–71.
2) Balani AR. Drug-induced pancreatitis : incidence, management and prevention. Drug Saf. 2008;31(10):823-37
3) Nitsche C et al. Drug-induced pancreatitis.Drug Saf. 2008;31(10):823-37
4) Koller EA et al. Pancreatitis Associated With Atypical Antipsychotics: From the Food and Drug Administration's MedWatch Surveillance System and Published Reports.Pharmacotherapy. 2003; 23:1123-30
5) Degner D et al. Pancreatitis associated with intake of psychotropc drugs, WPA World Congress of Psychiatry, 2014, abstract book 4/21
Competing interests: No competing interests