Expert urges caution on incretins data

New data on the safety of incretin based drug treatments for type 2 diabetes suggests no clear causal role in the development of pancreatic cancer – but could result in a heightened threat of heart failure in patients with increased cardiovascular risk.

However a leading Australian endocrinologist has urged clinicians not to abandon the use of these drugs, as the findings are based on short-term studies, and the treatments remain useful and valid for patients with type 2 diabetes.

“There is still some concern, but it’s not a confirmed effect of this drug,” Associate Professor Stephen Stranks, director of Southern Adelaide Diabetes and Endocrine Services said.

“For practising clinicians it’s something to keep in the back of our minds.”

The data is discussed in an editorial in the British Medical Journal, and the authors concede that while incretin based drugs “do not seem to increase the short-term risk of pancreatic cancer compared with sulfonylureas,” there was still a need for more evidence.

“As the use of incretin based drugs increases over time, longer term analyses of their use as monotherapy and in combination will provide more conclusive evidence,” they wrote.

“DPP-4 inhibitors do seem to increase the risk of hospital admission for heart failure among people with an increased cardiovascular risk. More evidence is needed to determine whether this risk is associated with all DPP-4 inhibitors and if it extends to patients without cardiovascular disease.”

Professor Stranks told the limbic that clinicians were probably already aware of links that had been made between incretin based drugs and pancreatic cancer and heart failure.

“There’s a question mark but it’s not a definite issue,” he said. “All of these studies are short-term. I think it’s certainly something that will continue to be monitored.”

He said the findings were helpful in risk management for individual patients on a case-by-case basis, especially for those with cardiovascular issues.

But he said incretin based drugs were “certainly a very useful medium-term treatment in type 2 diabetes.”

“DPP-4 inhibitors certainly improve glucose control,” he said. “The nett effect of these drugs is almost certainly positive.”

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