Acute pancreatitis with gliptins: Is it a clinical reality?

There are reports of acute pancreatitis with the use of dipeptidyl peptidase-4 inhibitors (gliptins). This class of drugs is widely being prescribed for type 2 diabetes mellitus (DM) in our country. We evaluated the incidence of acute pancreatitis with the use of gliptins during the period January 2012-June 2013. Patients of type 2 DM on treatment with any of the gliptins (Sitagliptin, vildagliptin, or saxagliptin) for at least 1 month duration were included. A total of 185 patients were included (205.3 patient years of follow-up). Five of them had history of acute pancreatitis (all mild) >6 months prior to inclusion with complete resolution and no chronic pancreatitis. One patient (0.48 per 100 patient years) presented with mild acute pancreatitis which resolved in 8 days. Asymptomatic elevation of serum amylase > 3× upper limit of normal was noted in five patients (2.4 per 100 patient years), without any sonological evidence of pancreatitis, which resolved on withdrawal of gliptins. None of the patients with previous history of pancreatitis had a recurrence of pancreatitis. In a group at low risk of acute pancreatitis, incidence of acute pancreatitis is low with the use of gliptins.