Using real‐world data to evaluate the association of incretin‐based therapies with risk of acute pancreatitis: a meta‐analysis of 1 324 515 patients from observational studies

Aim To investigate the real‐world incidence of acute pancreatitis ( AP ) associated with incretin‐based therapy ( IBT ). Methods We carried out a systematic review and meta‐analysis of observational studies using Medline, PubMed , Embase, the Cochrane Database, ClinicalTrials.gov and conference proceedings. We included: those studies in which AP was a pre‐defined clinical outcome; longitudinal studies (case–control, cohort); studies that adjusted for confounders; studies that reported on a population exposed to IBT ; studies in which non‐ IBT users or past users (who received IBTs >90 days before the index date) were used as the control group; studies that reported risk estimates [relative risks, odds ratios ( ORs ) or hazard ratios] with 95% confidence intervals ( CIs ) for AP event with IBT use, or that reported sufficient data to estimate these; and publications in the English language. Data were extracted by two independent investigators, and a consensus was reached with involvement of a third. Study‐specific ORs from seven cohort studies and two case–control studies were meta‐analysed using random‐effects models. Associations were tested in subgroups representing different patient characteristics and study quality. Results A total of nine studies that included 1 324 515 patients and 5195 cases of AP were included in our meta‐analysis. The summary estimate of OR for an association between IBT and AP was 1.03 (95% CI 0.87–1.20). Conclusions The present meta‐analysis of real‐world data does not suggest that IBT is associated with AP . Although we should continue to remain vigilant, IBTs should be regarded as reasonable options to consider adding to the regimen of a patient with type 2 diabetes.