37 Depot Medroxyprogesterone Acetate in the Management of Recurrent Acute Pancreatitis in Patients With Cystic Fibrosis Gene Mutations

Abstract

INTRODUCTION: In patients presenting with recurrent acute pancreatitis, cystic fibrosis (CF) gene variants are found at an increased frequency. Pancreatitis also occurs in patients being followed with CF mutations, generally occurring in patients with less severe mutations or in the setting of CF-related sorder (CFRD). There are no established treatment options for CF mutation-related pancreatitis. Some evidence has suggested that lung function fluctuates during the menstrual cycle, and in CF, that estradiol may inhibit chloride secretion. It has been hypothesized that hormonal contraceptives could play a role in modulating the disease process in women with CF. This study examined the impact of depot medroxyprogesterone acetate on the course of recurrent pancreatitis in female patients with established CF gene mutations. METHODS: In this single center retrospective study, medical records of all adult female patients with CF and acute recurrent pancreatitis between 2008–2018 were reviewed. Patients were included if they had experienced at least two episodes of acute pancreatitis, had been started on depot medroxyprogesterone, and had at least one CF gene mutation. Patients were excluded if they had developed pancreatitis from gallstones or heavy alcohol use. Total hospitalizations, episodes of pancreatitis, and average lipase values were examined and compared before and after the initiation of the depot medroxyprogesterone. RESULTS: A total of 13 patients met the study screening criteria and were recommended to start depot medroxyprogesterone. All patients were Caucasian females with a mean age of 45 years. The average time of treatment from which the endpoints were collected was 5.6 months. After the initiation of the depot medroxyprogesterone, there were no episodes of acute pancreatitis and one hospitalization unrelated to pancreatitis. The average lipase values were significantly decreased (261 units/L vs 41 units/L, P = 0.039) after the patients had been started on depot medroxyprogesterone. CONCLUSION: In this cohort, there were no further episodes of recurrent acute pancreatitis following the initiation of depot medroxyprogesterone in female patients with CF mutations. This data will be combined with other institutions shortly to examine the outcomes in a larger retrospective sample. A multicenter prospective study is being developed to study the outcomes being seen clinically and reported here in this sample.