隐形仿真药和急性胰腺炎:敌人还是无辜的旁观者?
Richard Pratley1, Zeb I Saeed2, Anna Casu1
1AdventHealth Translational Research Institute, Orlando, Florida.
Current opinion in gastroenterology
|July 5, 2024
概括
针对2型糖尿病和肥胖症的基于因克雷丁的药物显示,与DPP-4抑制剂一起发生胰腺炎的风险很小,但不是GLP-1RAs. 建议在患者之前有胰腺炎或胆囊问题时谨慎使用.
科学领域:
- 胃肠病学 胃肠病学
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 胰岛素增强剂和模仿剂,如DPP-4抑制剂和GLP-1受体激动剂 (GLP-1RA),广泛用于2型糖尿病 (T2D).
- 现在GLP-1RA和GLP-1/GIP协激剂也已被批准用于治疗肥胖症,增加了它们的使用.
- 胰腺外分细胞中存在GLP-1受体,这引发了关于胃肠道不良事件的问题.
研究的目的:
- 审查证据,将基于胰岛素的药物 (DPP-4抑制剂,GLP-1RA,GLP-1/GIP协激剂) 与急性胰腺炎联系起来.
- 检查与其他胃肠病相关的不良事件的关联,包括胆囊疾病和胰腺癌.
主要方法:
- 随机对照试验和元分析的系统审查.
- 来自临床试验的数据分析,调查针对T2D和肥胖症的基于隐素的疗法.
主要成果:
- 分析表明,使用DPP-4抑制剂会增加急性胰腺炎的风险,但使用GLP-1RA或协同激动剂不会增加.
- 胆囊炎和胆囊病 (胆囊病) 可能在GLP-1RA和GLP-1/GIP共激剂中更频繁.
- 没有证据表明与这些基因克雷类药物相关的胰腺癌风险增加.
结论:
- 基于因克雷丁的疗法对T2D和肥胖有价值,但在有胰腺炎病史的患者中需要谨慎.
- 在使用GLP-1RA和GLP-1/GIP共激素剂时,也应对已经存在胆囊疾病的患者进行监测.
相关概念视频
01:24Glucagon-like Receptor Agonists
313
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
313
01:23Dipeptidyl Peptidase 4 Inhibitors
180
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
180
01:30Acute Pancreatitis II: Clinical Manifestations and Management
118
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
118
01:27Acute Pancreatitis I: Introduction
353
Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
353
01:19Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
169
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
Acarbose and miglitol are...
169
01:24Chronic Pancreatitis I: Introduction
86
The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
86