Incretin-based therapy: Is the risk of pancreatitis driven by cardiovascular disease?

Incretin-based therapies are normally prescribed to individuals with type 2 diabetes but has recently come under scrutiny due to the possibility of associated pancreatitis. A 2014 systematic review published in the BMJ found no increase risk of acute pancreatitis in adults with type 2 diabetes, as partly evident from the meta-analysis of RCTs (OR=1.11, 95% CI 0.57-2.17). By contrast, a second meta-analysis added 3 large outcome trials in patients with previous cardiovascular disease to the previous 55 RCTs from Li et al. and showed an increased risk in acute pancreatitis. While the discrepancy in result may be due to better quality large trials, as the authors suggest, it is likely that since the large outcome trials investigated patients with cardiovascular disease, the increased risk is present only in this group.