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Januvia, Byetta, and Pancreatic Cancer

Type-2 diabetes is the most prevalent form of diabetes in America. 25.8 million children and adults in the US are being treated for the condition. Each year almost 2 million more people are diagnosed. In 2012 alone, the treatment cost of type-2 diabetes in the United States was $176 billion.

Two new drugs, Januvia and Byetta, offer new ways of treating diabetes.  By all accounts, they work well in treating diabetes.  But these drugs have also been linked to increased rates of pancreatic cancer.

The Theory That Links Januvia and Byetta to Pancreatic Cancer

These drugs behave differently than older pharmaceuticals, so here’s a quick breakdown of the science behind each treatment. Type-2 diabetes is caused by hyperglycemia in the context of inadequate insulin secretion and insulin resistance.

These new drugs treat type-2 diabetes by using the gut hormone, glucagon-like peptide 1 (GLP-1). This hormone is naturally secreted by endocrine cells in response to eating food and it increases glucose-medicated insulin secretion. This means that GLP-1 tells the pancreas to make insulin. During this process, the hormone is degraded by the enzyme dipeptidyl peptidase-4 (DPP-4). Januvia and Byetta treat diabetes by sustaining GLP-1 receptor activation. Byetta, an injectable drug, does this by being a GLP-1 agonist that resists DPP-4 degradation. Januvia (sitagliptin), an oral drug, uses inhibitors of DPP-4 to enhance the levels of endogenously secreted GLP-1. So essentially these drugs get to the same problem by starting at different ends; Byetta adds chemicals that act like GLP-1 and Januvia inhibits the DPP-4, which degrades the natural GLP-1.

Recent studies have confirmed that drugs that act like GLP-1 inflame the pancreas. By spiking hormone levels, the drugs change the normal GLP-1 pathway to the pancreas and also speed up the creation of the cells that line the pancreatic duct.

The problem is that researchers also believe that pancreatic cancer usually starts in those exact duct and islet cells. One UCLA study referenced FDA statistics to observe a six-fold increase in cases of pancreatitis in Byetta and Januvia users.   Let’s say those numbers are inflated a little.  There are still unbelievable and they still underscore what these drugs are doing to the pancreas.  Additionally, the study also found a 2.9-fold increase in pancreatic cancer in those using Byetta and a 2.7-fold increase in pancreatic cancers for those using Januvia. Both drugs are also linked to increased rates of thyroid cancer, but not other cancers, generally.

These findings are likely because diabetes drugs are used for lengthy periods of time. Type-2 diabetes does not have a cure, thus patients can be on a single treatment for decades. If patients were using Byetta or Januvia for a short period of time, it is likely that the pancreatic cancer correlation would not persist because the duct cells would not be over-stimulated every day.

The makers of Byetta One possible mitigating explanation for these health correlations is the fact that a high percentage of people with type-2 diabetes also suffer from being overweight. Being obese or overweight is directly linked to pancreatic cancer. For patients with a family history of pancreatic cancer, insulin and metformin could be safer alternative treatments. In fact, researchers have found that using Januvia when taking metformin removes the threat of increased pancreatitis. The link between weight and pancreatic cancer doesn’t eliminate the risks these drugs can pose, rather it is one part of the equation.

If you believe that you or a loved one may be able to link Januvia or Byetta to pancreatic cancer, contact us online or call us at 800.553.8082.