MRI abdomen showing pancreatic necrosis compressing on the common bile duct

Acute Necrotizing Pancreatitis Associated with Vildagliptin

Purnima Kunjathaya, Pradeep Kakkadasam Ramaswami, Anupama Nagar Krishnamurthy, Naresh Bhat

Abstract


Context To report a case of acute necrotizing pancreatitis in a patient receiving vildagliptin. Case report A 49-year-old man presented to us with severe abdominal pain and was diagnosed to have pancreatitis three weeks after the commencement of vildagliptin for the treatment of uncontrolled type 2 diabetes mellitus. His serum amylase was 2,215 U/L at admission, with contrast enhanced computed tomography (CECT) of the abdomen and pelvis showing features of acute pancreatitis. The patient had a prolonged hospital course and underwent laparoscopic pancreatic necrosectomy to relieve him of his biliary obstruction and an endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting as he had an avulsion of the cystic duct during surgery. Conclusions Acute pancreatitis as a complication of other incretin-based therapy like sitagliptin and exenatide is known and well reported, and has prompted the US Food and Drug Administration to issue an alert on these drugs. This appears to be the first reported case of acute necrotizing pancreatitis in a patient receiving vildagliptin in India and reinforces the need to be more judicious in the use of this medication.

Image: MRI abdomen showing pancreatic necrosis compressing on the common bile duct.


Keywords


Dipeptidyl-Peptidase IV Inhibitors; exenatide; Glucagon-Like Peptide 1; Incretins; liraglutide; sitagliptin

Full Text:

HTML PDF

References


Richter B, Bandeira-Echtler E, Bergerhoff K, Lerch C. Emerging role of dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes. Vasc Health and Risk Manag 2008;4:753-768. [PMID: 19065993]

Engel SS, Williams-Herman DE, Golm GT, Clay RJ, Machotka SV, Kaufman KD, Goldstein BJ. Sitagliptin: review of preclinical and clinical data regarding incidence of pancreatitis. Int J Clin Pract June 2010; 64(7); 984–990. [PMID: 20412332]

Tripathy NR, Basha S, Jain R, Shetty S, Ramachandran A. Exenatide and acute pancreatitis. J Assoc Physicians India 2008;56:987-988. [PMID: 19322980]

Iyer SN, Drake AJ 3rd, West RL, Mendez CE, Tanenberg RJ. Case report of acute necrotizing pancreatitis associated with combination treatment of sitagliptin and exenatide. Endocr Pract. 2012 Jan-Feb; 18(1):e10-3. [PMID: 22068258]

U.S. Food and Drug Administration. MedWatch 2009 Safety Alerts for Human Medical Products: Sitagliptin - acute pancreatitis. (http://www.fda.gov/safety/MedWatch/Safety Information/Safety Alerts for Human Medical Products/ucm183800.htm) September 25, 2009.

U.S. Food and Drug Administration. Information for healthcare professionals: Exenatide: (www.fda.gov/drugs/drugsafety/postmarket drug safety information for patients and providers/ucm124713.htm) August 8, 2008.

Lee PH, Stockton MD, and Franks AS. Acute pancreatitis associated with Liraglutide. Ann Pharmacother 2011; 45:e22. [PMID: 21487080]

Famularo G, Gasborrone L, Minisola G. Pancreatitis During Treatment with Liraglutide. JOP 2012 Sep 10; 13(5):540-541. [PMID: 22964963]

Girgis, CM and Champion, BL. Vildagliptin-induced pancreatitis. Endocr Pract 2011;17:e48-e50. [PMID: 21324812]

Williams-Herman D, Engel SS, Round E et al. Safety and tolerability of sitagliptin in clinical studies: a pooled analysis of data from 10,246 patients with type 2 diabetes. BMC Endocr Disord 2010;10:7. [PMID: 20412573]

Ligueros-Saylan M, Foley JE, Schweizer A, Couturier W, Kothny W. An assessment of adverse effects of vildagliptin versus comparators on the liver, the pancreas, the immune system, the skin and in patients with impaired renal function from a large pooled database of phase II and III clinical trials. Diabetes Obes Metab 2010;12(6):495-509. [PMID: 20518805]

Lai SW, Muo CH, Liao KF, Sung FC, Chen PC. Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti-diabetic drugs: apopulation-based cohort study in Taiwan. Am J Gastroenterol. 2011 Sep;106(9):1697-704. [PMID: 21577242]

Gonzalez-Perez A, Schlienger RG, Rodríguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs:a population-based cohort study. Diabetes Care. 2010 Dec;33(12):2580-5. [PMID: 20833867]

Noel RA, Braun DK, Patterson RE, Bloomgren GL. Increased risk of acute pancreatitis and biliary disease observed inpatients with type 2 diabetes: a retrospective cohort study. Diabetes Care. 2009 May;32(5):834-8. [PMID: 19208917]

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. [PMID: 20682680]

Solanki NS, Barreto SG, Saccone GT.Acute pancreatitis due to diabetes: the role of hyperglycaemia and insulin resistance. Pancreatology. 2012 May-Jun;12(3):234-9. [PMID: 22687379]

Butler P, Elashoff M et al. Pancreatitis, Pancreatic, and Thyroid Cancer With Glucagon-Like Peptide-1–Based Therapies. Gastroenterology 2011;141:150–156. [PMID: 21334333]

Butler AE, Galasso R, Matveyenko A, Rizza RA, Dry S, Butler PC. Pancreatic duct replication is increased with obesity and type 2 diabetes in humans. Diabetologia 2010;53:21-26. [PMID: 19844672]

Matveyenko AV, Dry S, Cox HI, et al. Beneficial endocrine but adverse exocrine effects of sitagliptin in the human islet amyloid polypeptide transgenic rat model of type 2 diabetes: interactions with metformin. Diabetes 2009;58: 1604 –1615. [PMID: 19403868]

Nachnani JS, Bulchandani DG, Nookala A, et al. Biochemical and histological effects of exendin-4 (exenatide) on the rat pancreas. Diabetologia 2010 Jan;53(1):153-9. [PMID:19756486]

Tatarkiewicz K, Smith PA, Sablan EJ, et al. Exenatide does not evoke pancreatitis and attenuates chemically induced pancreatitis in normal and diabetic rodents. Am J Physiol Endocrinol Metab 2010;299:E1076 –E1086. [PMID: 20923958]

Koehler JA, Baggio LL, Lamont BJ, et al. Glucagon-like peptide-1- receptor activation modulates pancreatitis-associated gene expression but does not modify the susceptibility to experimental pancreatitis in mice. Diabetes 2009; 58:2148-61. [PMID 19509017]

DeFronzo RA, Ratner RE, Han J, et al. 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. [PMID: 15855572]

Nyborg NC, Mølck AM, Madsen LW, et al. The human GLP-1 analog liraglutide and the pancreas: evidence for the absence of structural pancreatic changes in three species. Diabetes 2012; 61:1243-9. [PMID 22338093]

Nitsche CJ, Jamieson N, Lerch MM, Mayerle JV. Drug induced pancreatitis. Best Prac Res Clin Gastroenterol 2010;24:143-155. [PMID: 20227028]




DOI: http://dx.doi.org/10.6092/1590-8577/1203

NBN: http://nbn.depositolegale.it/urn%3Anbn%3Ait%3Aunina-16211

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 1590-8577 | JOP is published by CAB - Center for Libraries at "Federico II" University of Naples using Open Journal System