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基于肠促胰岛素的抗糖尿病治疗与胰腺疾病(胰腺炎、胰腺癌)

[Incretin-based antidiabetic treatment and diseases of the pancreas (pancreatitis, pancreas carcinoma)].

作者信息

Jermendy György

机构信息

Bajcsy-Zsilinszky Kórház Budapest, Maglódi út 89-91., 1106.

出版信息

Orv Hetil. 2016 Apr 3;157(14):523-8. doi: 10.1556/650.2016.30409.

Abstract

In the last couple of years incretin-based antidiabetic drugs became increasingly popular and widely used for treating patients with type 2 diabetes. Immediately after launching, case reports and small case series were published on the potential side effects of the new drugs, with special attention to pancreatic disorders such as acute pancreatitis or pancreatic cancer. As clinical observations accumulated, these side-effects were noted with nearly all drugs of this class. Although these side-effects proved to be rare, an intensive debate evolved in the literature. Opinion of diabetes specialists and representatives of pharmaceutical industry as well as position statements of different international scientific boards and health authorities were published. In addition, results of randomized clinical trials with incretin-based therapy and meta-analyses became available. Importantly, in everyday clinical practice, the label of the given drug should be followed. With regards to incretins, physicians should be cautious if pancreatitis in the patients' past medical history is documented. Early differential diagnosis of any abdominal pain during treatment of incretin-based therapy should be made and the drug should be discontinued if pancreatitis is verified. Continuous post-marketing surveillance and side-effect analysis are still justified with incretin-based antidiabetic treatment in patients with type 2 diabetes.

摘要

在过去几年中,基于肠促胰岛素的抗糖尿病药物越来越受欢迎,并广泛用于治疗2型糖尿病患者。新药一经推出,就有病例报告和小型病例系列发表,内容涉及这些新药的潜在副作用,尤其关注胰腺疾病,如急性胰腺炎或胰腺癌。随着临床观察的积累,几乎这类所有药物都出现了这些副作用。尽管这些副作用被证明很罕见,但文献中展开了激烈的争论。糖尿病专家和制药行业代表的观点以及不同国际科学委员会和卫生当局的立场声明都已发表。此外,基于肠促胰岛素治疗的随机临床试验结果和荟萃分析也已可得。重要的是,在日常临床实践中,应遵循所用药物的标签说明。对于肠促胰岛素,如果患者既往病史中有胰腺炎记录,医生应谨慎使用。在基于肠促胰岛素的治疗过程中,应对任何腹痛进行早期鉴别诊断,如果证实为胰腺炎,应停用该药物。对于2型糖尿病患者,基于肠促胰岛素的抗糖尿病治疗仍有必要进行持续的上市后监测和副作用分析。

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