(237) Dipeptidyl Peptidase-4 Inhibitors and Acute Pancreatitis - A Systematic Review of Descriptive Studies

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1282

Presenting Author(s)

Fathima Thashreefa Basheer, PharmD
– Udupi, Karnataka, India

Co-Author(s)

Leelavathi D Acharya
– Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Karnataka, India
Girish Thunga
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India
Rashmi Shetty
– Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Viji Pulikkel Chandran
– Research Scholar, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Muhammed Rashid, MPharm, BPharm
– Research Scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Udupi, Karnataka, India

Background: Dipeptidyl-peptidase-4(DPP-4) inhibitors are widely used to treat type 2 diabetes mellitus (T2DM) because of non-hypoglycemic and weight-neutral effects. However, the risk of acute pancreatitis(AP) in patients with DPP-4 inhibitors is unclear and limited. Previous studies revealed conflicting results between DPP-4 inhibitors' use and the development of AP.

Objectives: The aim of our study was to investigate the association between DPP-4 inhibitor and AP by a systematic review of case reports. Case reports clearly demonstrate patient demographics, clinical manifestation, management, and outcome at the individual patient level, which will help to identify the
association between DPP-4 inhibitors and AP.

Methods: PubMed/Medline and Scopus databases were searched from inception till September 2021 using MeSH terms "DPP-4 inhibitors" and "pancreatitis" to find case reports on AP induced by DPP-4 inhibitors in T2DM patients. Two independent reviewers were involved in title and abstract screening, full-text screening, data extraction, and quality assessment, disputes were addressed by a discussion with a third reviewer. Microsoft Excel was used for screening and extraction; SPSS version 20.0 was used for statistical analysis.

Results: A total of 27 AP cases, were identified by the use of various DPP-4 inhibitors such as Sitagliptin(n=11), Vildagliptin(n=9), Linagliptin(n=3), Saxagliptin(n=3), and Alogliptin(n=1). The range of onset of ADR was 8 to 1091 days. AP was confirmed by positive imaging, elevated pancreatic enzymes, and abdominal pain in the included case reports. Immediate withdrawal of DPP-4 inhibitors and symptomatic management along with intravenous fluid infusion, bowel rest, and hydration were the mainstays of treatment.

Conclusions: Our systematic review findings reveal the risk of AP associated with the use of DPP-4 inhibitors. Results of this review will aware physicians for monitoring the pancreatic safety of these classes of drugs. As we considered case reports only, further large well-
conducted observational studies and randomized controlled trials are needed to confirm our study results.