College of Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA.
Ann Pharmacother. 2011 Apr;45(4):e22. doi: 10.1345/aph.1P714. Epub 2011 Apr 12.
To report what is, to our knowledge, the first postmarketing case of acute pancreatitis associated with liraglutide.
A 60-year-old female with type 2 diabetes presented with a 16-hour history of mid-epigastric pain 3 weeks after treatment was changed from exenatide 10 μg twice daily, which she had taken for 4 years, to liraglutide 1.8 mg daily. Her serum lipase level was elevated (478 units/L) at admission, and other laboratory values were within normal limits. Liraglutide was discontinued at admission. Standard therapy for pancreatitis resulted in symptom resolution and a significant decrease in serum lipase (131 units/L) by hospital day 4; she was discharged on hospital day 5.
Based on the Naranjo scale, this case represents a probable adverse drug reaction. Eight cases of pancreatitis were observed in liraglutide-treated patients in premarketing clinical trials. Extensive literature describing exenatide-related pancreatitis and premarketing reports of liraglutide-related pancreatitis, along with the temporal relationship between the initiation of liraglutide and the onset of this patient's symptoms, suggest that the episode of pancreatitis was induced by liraglutide.
Liraglutide should be used cautiously in patients with a history of pancreatitis, and clinicians should have a high index of suspicion for this rare, but potentially serious, adverse effect.
报告我们所知的首例与利拉鲁肽相关的急性胰腺炎上市后病例。
一名 60 岁女性，患有 2 型糖尿病，在接受利拉鲁肽 1.8mg 每日治疗 3 周后出现上腹痛 16 小时，此前她已接受艾塞那肽 10μg 每日 2 次治疗 4 年。入院时血清脂肪酶升高（478 单位/L），其他实验室值正常。入院时停用利拉鲁肽。胰腺炎的标准治疗导致症状缓解，入院第 4 天血清脂肪酶（131 单位/L）显著下降；她于入院第 5 天出院。
根据 Naranjo 量表，该病例为可能的药物不良反应。在上市前临床试验中，有 8 例利拉鲁肽治疗患者出现胰腺炎。广泛的文献描述了与艾塞那肽相关的胰腺炎和上市前报告的与利拉鲁肽相关的胰腺炎，以及利拉鲁肽开始使用与该患者症状发作之间的时间关系，表明该胰腺炎发作是由利拉鲁肽引起的。
有胰腺炎病史的患者应谨慎使用利拉鲁肽，临床医生应高度怀疑这种罕见但潜在严重的不良反应。
