S235 GLP1-RA-Based Medications in Patients With Obesity and Chronic Pancreatitis Are Associated With Decreased Cardiac Events Without Increased Risk of Pancreatic Cancer

Introduction: Glucagon-like peptide-1 agonist-based medication (GLP-1RA) use has risen by 600% among Americans with obesity over the last six years. Prior studies have shown that GLP1-RA use decreases the incidence of major adverse cardiac events (MACE) in patients with obesity. However, given the association of GLP1-RA use with pancreatitis and the theoretical concern for pancreatic cancer, their use in patients with chronic pancreatitis (CP) remains unclear. We investigated the association of GLP1-RA use and CP incidence as well as the risk of pancreatic cancer and MACE in those with CP and obesity. Methods: We performed a retrospective cohort study using ICD.10 codes using the TriNetX, a healthcare database with over 119 million patients in the United States. In the first analysis, among obese patients with pre-existing CP, we compared the 5-year incidence of MACE (acute myocardial infarction, stroke, acute heart failure, unstable angina) and pancreatic cancer between GLP1-RA (tirzepatide, liraglutide, dulaglutide, or semaglutide) users and non-users. Both groups had exclusions of history of prior pancreatic cancer. In the next analysis, we compared the 5-year incidence of CP between patients with obesity with and without GLP1-RA use. Patients with prior CP or pancreatic cancer were excluded. In both analyses, cohorts were propensity score matched on age, sex, tobacco use, alcohol use, hypertension, diabetes mellitus, hyperlipidemia, and obesity. P-values < 0.05 were statistically significant. Results: Among 18,352,024 patients with obesity in the database, there were 48,956 patients with obesity and CP, and of those, 3,739 patients who were prescribed a GLP-1RA in this study. After propensity score matched, patients with obesity, CP, and GLP1-RA use had a lower incidence of MACE (6.59% vs 11.33%, odds ratio [OR] 0.55 [0.46, 0.66]) and pancreatic cancer (0.45% vs 3.25%, OR 0.14 [0.08, 0.23]) compared to those without GLP-1RA use. Further, patients with obesity and GLP1-RA use had decreased risk of developing CP (0.12% vs 0.33%, OR 0.36 [0.34, 0.39]) compared to those without GLP1-RA use. Conclusion: Our findings indicate that among patients with obesity and chronic pancreatitis, GLP1-RA use is associated with a significantly decreased risk of both MACE and pancreatic cancer. Among patients with obesity, GLP1-RA use did not result in increased incidence of developing CP. These results support the continued use of GLP1-RA in obese patients with chronic pancreatitis.