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No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer

BACKGROUND: Glucagon‐like peptide‐1 receptor agonists, such as dulaglutide, exenatide and liraglutide, are approved to treat Type 2 diabetes mellitus. Although these drugs provide substantial glycaemic control, studies in rodents have prompted concerns about the development of medullary thyroid carc...

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Autores principales: Sherman, S. I., Kloos, R. T., Tuttle, R. M., Pontecorvi, A., Völzke, H., Harper, K., Vance, C., Alston, J. T., Usborne, A. L., Sloop, K. W., Lakshmanan, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838554/
https://www.ncbi.nlm.nih.gov/pubmed/28755389
http://dx.doi.org/10.1111/dme.13437
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author Sherman, S. I.
Kloos, R. T.
Tuttle, R. M.
Pontecorvi, A.
Völzke, H.
Harper, K.
Vance, C.
Alston, J. T.
Usborne, A. L.
Sloop, K. W.
Lakshmanan, M.
author_facet Sherman, S. I.
Kloos, R. T.
Tuttle, R. M.
Pontecorvi, A.
Völzke, H.
Harper, K.
Vance, C.
Alston, J. T.
Usborne, A. L.
Sloop, K. W.
Lakshmanan, M.
author_sort Sherman, S. I.
collection PubMed
description BACKGROUND: Glucagon‐like peptide‐1 receptor agonists, such as dulaglutide, exenatide and liraglutide, are approved to treat Type 2 diabetes mellitus. Although these drugs provide substantial glycaemic control, studies in rodents have prompted concerns about the development of medullary thyroid carcinoma. These data are reflected in the US package insert, with boxed warnings and product labelling noting the occurrence of these tumours after clinically relevant exposures in rodents, and contraindicating glucagon‐like peptide‐1 receptor agonist use in people with a personal or family history of medullary thyroid carcinoma, or in people with multiple endocrine neoplasia type 2. However, there are substantial differences between rodent and human responses to glucagon‐like peptide‐1 receptor agonists. This report presents the case of a woman with pre‐existing medullary thyroid carcinoma who exhibited no significant changes in serum calcitonin levels despite treatment with dulaglutide 2.0 mg for 6 months in the Assessment of Weekly AdministRation of LY2189265 [dulaglutide] in Diabetes‐5 clinical study (NCT00734474). CASE REPORT: Elevated serum calcitonin was noted in a 56‐year‐old woman with Type 2 diabetes mellitus at the 6‐month discontinuation visit in a study of long‐term dulaglutide therapy. Retroactive assessment of serum collected before study treatment yielded an elevated calcitonin level. At 3 months post‐study, calcitonin level remained elevated; ultrasonography revealed multiple bilateral thyroid nodules. Eventually, medullary thyroid carcinoma was diagnosed; the woman was heterozygous positive for a germline RET proto‐oncogene mutation. CONCLUSION: The tumour was not considered stimulated by dulaglutide therapy because calcitonin remained stable throughout.
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spelling pubmed-58385542018-03-12 No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer Sherman, S. I. Kloos, R. T. Tuttle, R. M. Pontecorvi, A. Völzke, H. Harper, K. Vance, C. Alston, J. T. Usborne, A. L. Sloop, K. W. Lakshmanan, M. Diabet Med Case Reports BACKGROUND: Glucagon‐like peptide‐1 receptor agonists, such as dulaglutide, exenatide and liraglutide, are approved to treat Type 2 diabetes mellitus. Although these drugs provide substantial glycaemic control, studies in rodents have prompted concerns about the development of medullary thyroid carcinoma. These data are reflected in the US package insert, with boxed warnings and product labelling noting the occurrence of these tumours after clinically relevant exposures in rodents, and contraindicating glucagon‐like peptide‐1 receptor agonist use in people with a personal or family history of medullary thyroid carcinoma, or in people with multiple endocrine neoplasia type 2. However, there are substantial differences between rodent and human responses to glucagon‐like peptide‐1 receptor agonists. This report presents the case of a woman with pre‐existing medullary thyroid carcinoma who exhibited no significant changes in serum calcitonin levels despite treatment with dulaglutide 2.0 mg for 6 months in the Assessment of Weekly AdministRation of LY2189265 [dulaglutide] in Diabetes‐5 clinical study (NCT00734474). CASE REPORT: Elevated serum calcitonin was noted in a 56‐year‐old woman with Type 2 diabetes mellitus at the 6‐month discontinuation visit in a study of long‐term dulaglutide therapy. Retroactive assessment of serum collected before study treatment yielded an elevated calcitonin level. At 3 months post‐study, calcitonin level remained elevated; ultrasonography revealed multiple bilateral thyroid nodules. Eventually, medullary thyroid carcinoma was diagnosed; the woman was heterozygous positive for a germline RET proto‐oncogene mutation. CONCLUSION: The tumour was not considered stimulated by dulaglutide therapy because calcitonin remained stable throughout. John Wiley and Sons Inc. 2018-02-13 2018-03 /pmc/articles/PMC5838554/ /pubmed/28755389 http://dx.doi.org/10.1111/dme.13437 Text en © 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Case Reports
Sherman, S. I.
Kloos, R. T.
Tuttle, R. M.
Pontecorvi, A.
Völzke, H.
Harper, K.
Vance, C.
Alston, J. T.
Usborne, A. L.
Sloop, K. W.
Lakshmanan, M.
No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title_full No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title_fullStr No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title_full_unstemmed No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title_short No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
title_sort no calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838554/
https://www.ncbi.nlm.nih.gov/pubmed/28755389
http://dx.doi.org/10.1111/dme.13437
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