Biliary disorders associated with the use of DPP-4 inhibitors and GLP-1 agonists

DPP-4 inhibitors and GLP-1 agonists are relatively new blood glucose lowering agents, whose side-effects profile is beginning to become clearer. Although their suspected side-effect of disorders of the bile duct and gall bladder remains to be confirmed in comparable studies, there are good reasons to take the possible association reported here seriously, as this research meets most of the criteria for causality defined by Sir Bradford Hill: strength of the association, consistency (in multiple studies), biological plausibility, temporal relationship and specificity. The only criterion that has not yet been met is that of consistency, so the results of this study still have to be confirmed by comparable investigations.

  1. Marzioni M, et al. Exendin-4, a glucagon-like peptide 1 receptor agonist, protects cholangiocytes from apoptosis. Gut 2009; 58: 990-997.
  2. Faillie JL, et al. Association of bile duct and gallbladder diseases with the use of incretin-based drugs in patients with type 2 diabetes mellitus. JAMA Intern Med 2016; 176: 1474-1481.

*The literature refers to the Dutch text.