From the Research
Starting GLP-1 agonist therapy such as liraglutide (Victoza) is generally not recommended in patients with hyperlipasemia, as it may increase the risk of pancreatitis, particularly in those with elevated lipase levels greater than 3 times the upper limit of normal. Patients with hyperlipasemia should avoid GLP-1 agonists due to the potential risk of further elevating pancreatic enzymes and potentially causing or exacerbating pancreatitis 1.
Alternative Treatment Options
If treatment for diabetes or weight management is needed in a patient with hyperlipasemia, alternative medication classes should be considered, such as:
- Metformin
- SGLT-2 inhibitors
- Insulin therapy depending on the clinical situation. Before initiating any alternative therapy, the cause of the elevated lipase should be investigated and addressed if possible.
Monitoring for Pancreatitis
If a patient on GLP-1 therapy develops symptoms suggestive of pancreatitis (severe abdominal pain, nausea, vomiting), the medication should be discontinued immediately and pancreatic enzymes should be measured. The risk of pancreatitis with these medications is relatively low in the general population, but significantly higher in those with pre-existing pancreatic enzyme abnormalities 2, 3.
Recent Study Findings
A recent study found that the use of GLP-1 receptor agonists did not increase the risk of pancreatitis in a comorbidity-free subgroup of patients with type 2 diabetes mellitus (T2DM) in the United States 2. However, another study suggested that GLP-1 agonists may be associated with a dose-dependent risk of pancreatitis 1.
Clinical Decision Making
In clinical practice, the decision to start GLP-1 agonist therapy in a patient with hyperlipasemia should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history. The potential benefits of GLP-1 agonist therapy should be carefully weighed against the potential risks, and alternative treatment options should be considered.