Predictors of acute pancreatitis in patients treated with GLP-1 receptor agonists for weight management

Jul 22, 2025Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]

Factors linked to sudden pancreas inflammation in people using GLP-1 drugs for weight loss

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Abstract

2.2% of patients developed acute pancreatitis after starting a GLP-1 receptor agonist for obesity management.

A history of gallstone disease is associated with a nearly threefold increased risk of acute pancreatitis with GLP-1RA use.
Patients with a prior history of acute pancreatitis have a nearly fivefold increased risk when treated with GLP-1RA.
Coronary artery disease or peripheral vascular disease is linked to a twofold increased risk of acute pancreatitis in this context.
Tobacco use is associated with a 2.4-fold increased risk of developing acute pancreatitis after starting GLP-1RA treatment.
Higher body mass index (BMI), specifically categories 36-40 and over 40, is associated with a lower risk of acute pancreatitis with GLP-1RA therapy.

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INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely prescribed for treating obesity and Type 2 Diabetes (T2D). There have been concerns that GLP-1RA is associated with acute pancreatitis (AP), although the data are controversial. We aimed to identify factors that impact the risk of AP after initiation of GLP-1RA treatment for obesity.

METHODS: We performed a retrospective case-control study including adults patients initiated on a GLP-1RA for obesity management to determine risk factors associated with AP in obese patients taking GLP-1RA. We identified patients initiated on GLP-1RA. A multivariable logistic regression model was used to identify predictors of AP with GLP-1RA use.

RESULTS: There were 2245 patients, of which 49 (2.2 %) developed AP after starting a GLP-1RA. A history of gallstone disease (adjusted odds ratio (aOR), 2.9 [95 % CI, 1.6 to 5.3]), history of AP (aOR 4.8 [CI, 1.8 to 13.2]), CAD/PVD (aOR 2 [CI, 1.01 to 3.9]) and tobacco use (aOR 2.4 [CI, 1.2 to 4.7]) were associated with a higher risk of AP with GLP-1RA use. Compared to a BMI ≤30 kg/m, BMI categories 36-40 and > 40 were associated with a lower risk of AP with GLP-1RA therapy, (aOR 0.2 [CI, 0.06 to 0.6]) and (aOR 0.25 [CI, 0.09 to 0.68]), respectively. 2

CONCLUSION: A history of gallstone disease, history of AP, CAD/PVD, and tobacco use were associated with AP after initiation of GLP-1RA for obesity treatment. A higher BMI appears to be protective against AP. Recognizing factors associated AP after GLP-1RA initiation can inform clinicians on risk stratification.

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Predictors of acute pancreatitis in patients treated with GLP-1 receptor agonists for weight management

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