GLP-1 drugs linked to pancreatitis, gallbladder problems

Users of weight-loss and diabetes therapies based on GLP-1 agonists have been warned to be aware of a rare complication, pancreatitis, that can be severe.

The UK medicines regulator, the MHRA, has updated the product information for healthcare professionals and patients regarding the "small risk of severe acute pancreatitis in patients taking GLP-1s."

While rare, the sheer scale of GLP-1 use in the UK – with one recent study suggesting 1.6 million adults had used them in the last 12 months, and 3.3 million were interested in trying them in the following year – makes it important for clinicians and patients to be aware of the warning signs of pancreatitis, said the regulator.

Symptoms can include severe, persistent stomach pain that may radiate to the back, as well as nausea and vomiting.

"For the vast majority of patients who are prescribed GLP-1s, they are safe and effective medicines, which deliver significant health benefits," said Alison Cave, the NHRA's safety officer. "The risk of developing these severe side effects is very small, but it is important that patients and healthcare professionals are aware and alert to the associated symptoms."

In the UK, the most commonly used GLP-1 therapies are Novo Nordisk's semaglutide-based Ozempic for diabetes and Wegovy for obesity, as well as Eli Lilly's Mounjaro (tirzepatide), which are all given as weekly injections. Both companies are also working on daily, oral GLP-1 products that could increase usage still further.

The MHRA is asking anyone who is taking GLP-1 medicines and experiences these symptoms to seek medical advice and report it via the regulator's Yellow Card scheme. Adverse drug reactions are estimated to cost the health service more than £2.2 billion ($3 billion) a year in hospital stays alone.

Last year, the agency partnered with Genomics England to use the UK Biobank to delve deeper into the risk of pancreatitis among GLP-1 users, to see if there is a genetic factor that elevates the risk.

A study in the US published last year found no increased risk of pancreatitis and suggested the drugs may, rather, be associated with a lower lifetime risk.

Cholecystectomy increase?

Meanwhile, a report by the BBC has asked whether widespread use of GLP-1 drugs could be leading to a spike in gallbladder removal surgeries – called cholecystectomies – which are currently being carried out at the highest level in a decade in the UK.

The president of the British Obesity and Metabolic Specialist Society, Ahmed Ahmed, told the news agency that "more and more" people undergoing these surgeries are telling him they have previously taken weight loss injections.

Acute pancreatitis is linked to the development of gallstones, which are listed as a side effect with GLP-1 drugs. Ahmed said it is not clear at the moment whether the drugs cause the gallstones or if they result from dramatic, rapid weight loss.

Image by Michal Jarmoluk from Pixabay