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Pancreatitis and Pancreatic Cancer, the Pain in the Ass with Ozempic?

Pancreatitis and Pancreatic Cancer, the Pain in the Ass with Ozempic?

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Pancreatitis and Pancreatic Cancer

Let’s talk about the pain in the ass of pancreatitis and pancreatic cancer. Pancreatitis means an inflammation of the pancreas. Kind of like the inflammation you experience when you roll your ankle while walking on a flat surface – both your ankle and ego are inflamed and hurting. Hopefully, pancreatic cancer is pretty self-explanatory. Here is a diagram of the pancreas to give you a bit more context – it is a little organ that sits behind the stomach in our upper abdomen and kind of looks like an upside-down Nike symbol!

Now, if you have ever had pancreatitis, you will know it is an unpleasant and painful experience. You were likely in the hospital for some time, doubled over in pain with a team of care providers that had little to offer other than supportive care and hopefully a few shots of morphine. As for pancreatic cancer, you may have heard of it as well. Unfortunately, it has a relatively poor prognosis for most individuals diagnosed with it compared to other cancers. It can progress quickly and often isn’t discovered until later stages when it has spread to other organs. For such a small organ, the pancreas can bring on a lot of grief, but it serves a pretty important role in helping to keep our blood sugar levels in check and our digestive processes operating optimally! 

Why am I so focused on such an awkward little organ?

There may be a linkage between those conditions and anti-obesity medications, particularly the GLP-1 receptor agonists (GLP-1 RAs) such as Ozempic, Bydureon, Saxenda, Trulicity and Wegovy. Pancreatitis, specifically chronic pancreatitis, can increase the risk of developing pancreatic cancer significantly. However, it is not clear if a single episode of pancreatitis, such as in the cases possibly linked to the GLP-1 RAs, will lead to the development of pancreatic cancer. The offending agent (the GLP-1 RA medication) is generally removed following an acute episode of pancreatitis, therefore, limiting the chance of progression to chronic pancreatitis! Chronic pancreatitis can develop due to genetics, alcohol use, elevated triglycerides, and other potential medications.

Now all of this gets even more confusing for a couple of reasons: 

  1. Individuals that have obesity and type 2 diabetes (the primary population using these medications) are unfortunately at a higher risk of developing pancreatitis due to their medical conditions! 
  2. In further trials with GLP-1 RAs such as Ozempic, the GLP-1 RA medication might actually be protective and prevent the development of pancreatic cancer!

I know. WTF?!

We need more research!

More research is necessary to confirm if there is indeed a risk or a benefit. Lame answer, I know. However, the silver lining is that the evidence is inconclusive, largely because instances of pancreatitis and pancreatic cancer are occurring at such a low rate that it is hard for us to detect yay, or nay, on the risk. Therefore, this tells us the risk is very low, and I would argue the risk for pancreatic cancer is near 0%. Now, by no means can we ignore this data, but you would essentially be winning the pancreas lottery if any of the above occurred. Even then, we would still need to rule out all of the other potential contributing variables to confirm if it was due to the medication or not. 

So I hope this provided you with some insight around GLP-1 RAs and pancreas issues! Of course, if you have other questions, please feel free to shoot me an email

Always remember small tweaks, lead to massive peaks!

Dr. Dan

 

References:

  1. Nauck, M. A. & Friedrich, N. Do GLP-1-based therapies increase cancer risk? Diabetes Care 36, S245–S252 (2013).
  2. Bethel, M. A. et al. Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis. Lancet Diabetes Endocrinol. 6, 105–113 (2018).
  3. Pfeffer, M. A. et al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N. Engl. J. Med. 373, 2247–2257 (2015).
  4. Holman, R. R. et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N. Engl. J. Med. 377, 1228–1239 (2017).
  5. Marso, S. P. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N. Engl. J. Med. 375, 1834–1844 (2016).
  6. Nordisk, N., Bagsvaerd, D.-M. & Hospi, S. J. Liraglutide and cardiovascular outcomes in type 2 diabetes. Drug and Therapeutics Bulletin vol. 54 101 (2016).

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