S1849 Watch out for Semaglutide: Potential Cause of Pancreatitis?

Introduction: Recent clinical trials (STEP program) have shown Semaglutide to be the cornerstone in type 2 diabetes and weight management. Here, we present a case of acute pancreatitis in a patient who was recently started on semaglutide for diabetes mellitus. Case Description/Methods: The 61-year-old female with the medical history of diabetes Mellitus type 2, hypertension, depression, and obesity (BMI 48.87) presented with one day of 10/10 upper quadrant abdominal pain radiating to her back associated with nausea. The patient denied any alcohol and recreational drug use. The patient had a cholecystectomy 5 years ago. On arrival, the patient's blood pressure was 178/80. Lab work was unremarkable except Liver function noted elevated: AST 324, ALT 140. Lipase level 4986. Her calcium level was normal, and her lipid panel was unremarkable. The patient was diagnosed with acute pancreatitis (AP) based on two out of three AP diagnostic criteria: characteristic abdominal pain, amylase and/or lipase ≥ 3ULN, and/or characteristic findings on pancreas imaging. GI was consulted. MRCP did not show any abnormalities or stones. She was continued on IVF and had a resolution of all symptoms the following day. She was also able to tolerate a solid diet well with no symptoms. Of note, the Patient was recently started on Ozempic 2 months ago. She was advised to discontinue Ozempic on discharge and discuss with PCP regarding other diabetes medications options Discussion: GLP 1 agonists are becoming more favored among diabetes mellitus type 2 patients due to weight loss, less risk of hypoglycemia, and better compliance. GLP-1 agonists directly stimulate GLP-1 receptors in pancreatic islet beta cells and exocrine duct cells which may cause an overgrowth of the cells that cover the smaller ducts, thereby resulting in hyperplasia, increased pancreatic weight, duct occlusion, back pressure, and subsequent acute or chronic pancreatic inflammation. Acute pancreatitis was observed with semaglutide at rates similar to placebo during the SUSTAIN-6 trial. However Pancreatitis associated with GLP 1 agonists might present with atypical presentation, therefore the prevalence might be underreported, and other database studies have also shown conflicting results. Given the nature of observational studies, data could have been confounded, since patients with diabetes who have an indication for GLP-1RA therapy often have concomitant risk factors for pancreatitis (obesity, longer diabetes duration, and co-medication).