GLP-1 agonists are a class of medications used to treat type 2 diabetes and obesity. They work by mimicking the effects of the hormone GLP-1, which regulates blood sugar and appetite. One of the concerns that have been raised about GLP-1 agonists is the potential risk of pancreatitis and pancreatic cancer. In this blog post, we'll explore the evidence on this topic and what it means for people taking GLP-1As.
Pancreatitis is a condition in which the pancreas becomes inflamed, leading to symptoms such as abdominal pain, nausea, and vomiting. Pancreatitis can be acute (short-term) or chronic (long-term) and can be caused by a variety of factors, including alcohol use, gallstones, and certain medications. Alcohol and gallstones are the most common causes of acute pancreatitis.
Pancreatic cancer is a type of cancer that begins in the cells of the pancreas. It is a relatively rare form of cancer, but it is often deadly because it tends to be diagnosed at an advanced stage. Some studies have suggested that GLP-1 agonists may increase the risk of pancreatic cancer, but the evidence is mixed.
For years, there have been multiple studies that have been done looking at the association between GLP-1 therapy and pancreatitis and pancreatic cancer. However, most studies have conflicting evidence, with some saying that there is a potential risk while others state that there is no association at all.
The association of GLP-1 and pancreatic disease stemmed from an observational study conducted in 2011 that suggested a relation between GLP-1 agonists and pancreatitis based on case studies and animal models (1). This led to the FDA issuing a warning about the risk of pancreatitis with GLP-1 agonist use. This study was then followed by diabetic rat models that further suggested the risk of pancreatitis and pancreatic cancer. However, multiple studies since that time showed no significant associations between GLP-1 agonists and pancreatic cancer…unless you are a rat.
A meta-analysis conducted in 2019 assessing if GLP-1 agonists were associated with pancreatic cancer showed that of the 12 trials reviewed, none showed an increased risk for pancreatic cancer compared to other treatments (2). Their findings seem to coincide with multiple other meta-analyses conducted from 2014-2018.
A review article published in 2013 reviewed the current literature on the risk of pancreatitis and pancreatic cancer for GLP-agonist therapy, which included the original rat model and observation studies (3). They identified two key things about those studies. First, the concerning histological findings were not reproduced in other similar models and varied with different GLP-1 therapies. Second, the observational studies that saw the increased risk for pancreatitis did not consider the risks of obesity, who are more likely to have gallstones or hypertriglyceridemia, in causing pancreatitis. Ultimately, the cardiovascular benefits seemed to outway the very, very low risk of pancreatitis and pancreatic cancer.
So, what does all of this mean for people taking GLP-1 agonists? First and foremost, it's important to understand that the risk of pancreatitis and pancreatic cancer with these medications appears to be very low. Nevertheless, if you are taking GLP-1 agonists, it's important to be aware of the signs and symptoms of pancreatitis, such as abdominal pain and nausea, and to contact your healthcare provider if you experience these symptoms.
It's also worth noting that GLP-1 agonists have been shown to have a range of benefits for people with type 2 diabetes and obesity, including improved blood sugar control, weight loss, and reduced risk of cardiovascular disease. If you are considering taking GLP-1As or are currently taking these medications, it's important to discuss any concerns you may have about pancreatitis or pancreatic cancer with your healthcare provider.
In conclusion, the evidence suggests that GLP-1 agonists do not significantly increase the risk of pancreatitis or pancreatic cancer. If you would like to learn more about GLP-1 medications or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Dr. Constantine Joseph Pella, MD
Boston University Medical Center