GLP-1 agonists-induced autoimmune pancreatitis

Two main types of autoimmune pancreatitis (AIP) have been described: type 1, linked to IgG4-related disease, and type 2, associated with inflammatory bowel diseases. Recently, a third type has been associated with immune checkpoint inhibitors. In our series, we report three cases of type 1 AIP following glucagon-like peptide (GLP)-1 agonist treatment for type 2 diabetes mellitus (DM). GLP-1 agonists may be implicated in pancreatitis development mainly due to their effect on biliary motility and pancreatic cell proliferation. While causation remains unproven, it could be possible that GLP-1 induced pancreatic hypertrophy might influence cell metabolism and antigen presentation in predisposed individuals, altering the immunological milieu and eventually leading to type 1 AIP. Similarly, we hypothesise that GLP-1 agonists use in type 1 AIP patients may lead to pancreatitis recurrence. Accordingly, insulin-based therapeutic regimens may be preferred in type 2 DM patients also affected by type 1 AIP.