GLP-1 Agonist Use in a Patient With an Explainable Cause of Pancreatitis

ABSTRACT Objective: To report the successful use of glucagon-like peptide-1 (GLP-1) receptor agonist therapy in the treatment of a patient with a history of hypertriglyceridemia-induced acute pancreatitis. Methods: The clinical presentation, laboratory data, and imaging studies for the acute pancreatitis episode and 1 year post-discharge follow-up are described. Results: A 51-year-old Caucasian male with a history of diabetes, hypertension, and dyslipidemia presented to the local Emergency Department with back pain, abdominal pain, nausea, and vomiting. His presenting laboratory values included serum lipase 7,901 U/L, serum amylase 39 U/L, and triglycerides 7,686 mg/dL. Abdominal computed tomography scan results were consistent with diffuse pancreatitis; ultrasound ruled out the presence of gallstones and the patient denied any history of alcohol abuse. The patient was diagnosed with acute pancreatitis due to hypertriglyceridemia. After discharge, the patient's serum triglyceride concentration was aggressively managed with combination anti-lipidemia therapy and his diabetes was subsequently treated with a GLP-1 receptor agonist. There was no recurrence of pancreatitis after 1 year of follow-up. Conclusion: GLP-1 receptor agonist product labels warn against their use in patients with a history of pancreatitis. This case illustrates that healthcare providers may consider subsequent GLP-1 therapy for patients with diabetes in whom a known cause of pancreatitis has been adequately managed. Abbreviations: A1C = glycosylated hemoglobin A1C EMA = European Medicines Agency FDA = Food and Drug Administration GLP-1 = glucagon-like peptide-1 T2DM = type 2 diabetes mellitus TG = triglyceride