Nizar Al-Salameh, DO
Danville, Pennsylvania
Nizar Al-Salameh, DO1, Ruchit N. Shah, DO1, Harshit S. Khara, MD, FACG2
1Geisinger Health System, Danville, PA; 2Geisinger Medical Center, Danville, PA
Introduction: Diabetes mellitus has been shown to increase the risk of developing acute pancreatitis (AP). Liraglutide is a glucagon-like peptide-1 (GLP-1) agonist used for the treatment of diabetes. Liraglutide has emerged as a preferred agent for the treatment of type II diabetes for its cardiovascular protective features and safety profile. One of the potential adverse effects of liraglutide is acute pancreatitis but we present an intriguing case of dose increment associated liraglutide-induced acute pancreatitis.
Case Description/Methods: A 53-year-old female with a medical history pertinent for type II diabetes mellitus presented to the hospital with 2-days of epigastric abdominal pain, nausea, and non-bilious emesis. Her liraglutide dose had been increased 2 days prior to her symptom onset from 1.2 mg to 1.8 mg. Physical exam revealed epigastric discomfort on palpation without peritoneal signs. Lipase was 240 U/L (normal: 16-63 U/L), CRP 16 mg/L (normal: 0-5 mg/L), normal LFTs, and triglycerides were 148 mg/dL (normal: < 200mg/dL). Abdominal ultrasound and CT of the abdomen showed no evidence of biliary pathology. In the absence of alcohol use, absence of biliary pathology with normal LFTs, or other medical conditions, the patient was diagnosed with acute pancreatitis, likely secondary to liraglutide after a recent dose increment. She was treated with supportive measures and discharged home with cessation of the medication with no symptom reoccurrence.
Discussion: GLP-1 agonists such as liraglutide, are thought to cause acute pancreatitis by inducing a pro-inflammatory state within the exocrine pancreas. During the clinical phases of liraglutide, there were 8 reported events of acute pancreatitis. Liraglutide was found to have higher incidence of acute pancreatitis of 1.6 cases/1000 patient year exposure (PYE) vs 0.7 cases/1000 PYE which included other oral diabetic agents such as glimepiride, rosiglitazone, insulin glargine, sitagliptin, and exenatide. For diabetic patients on GLP-1 analogs admitted with acute pancreatitis, it is therefore important to consider the medication or its dose adjustment as a possible cause, especially in the absence of other common etiologies. This was a rare presentation of dose adjusted liraglutide induced acute pancreatitis.
Citation: Nizar Al-Salameh, DO; Ruchit N. Shah, DO; Harshit S. Khara, MD, FACG. P1849 - DOSE INCREMENT-ASSOCIATED LIRAGLUTIDE-INDUCED ACUTE PANCREATITIS. Program No. P1849. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.