The association between linagliptin and acute pancreatitis: A review

Hyder Osman Mirghany, Abdulmohsen Mohammed Alamri, Muath Fayez Karkar, Muath Saud Alyasi, Ahmed Abdulrahman Albalawi, Abdullah Ali Aljaafari, Dhafer Mohammed Alyami, Mohammed Hussain Alzahib


Linagliptin is a Dipeptidyl Peptidase inhibitor (DPP-4i) with rare hypoglycaemic episodes and no need for renal adjustment. However, acute pancreatic is a major concern.

The current review aimed to assess the relationship between linagliptin and acute pancreatitis.

A systematic electronic search was conducted in PubMed, MEDLINE, and the first hundred articles of Google Scholar for relevant articles. All human studies published during the period from 2006 to October 2019 were eligible. Studies on animals, experimental studies, and reviews were excluded. The search terms linagliptin, acute pancreatitis, chronic pancreatitis, and DPP-4i with protean AND or OR were used One hundred and thirty-two articles were retrieved and only six met the inclusion and exclusion criteria. The author's name, country of origin, date of publication, type of study, number of patients, and the duration were reported.

There were 132 studies (thirty-two in Pub Med and MEDLINE and the first hundred articles in Google Scholar), out of fourteen full texts reviewed, only six studies were eligible. Three were meta-analyses (showed no association of linagliptin with acute pancreatitis, a pooled analysis of 22 randomized controlled trials supported the above observation, while a recent randomized controlled trial concluded acute pancreatitis in 0.3 per cent in linagliptin arm vs. 0.1 per cent placebo of which 2/9 were fatal. The last study was a case report at a high risk of acute pancreatitis due to multiple gallstones and diuretics use.

Acute pancreatitis was not higher among linagliptin users. Physicians need to take the benefits of this weight and cardiovascular risk-neutral drug with no need for renal adjustment.
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