Drug-induced Acute Pancreatitis: Anecdotal Evidence vs Prospective Evaluation

Abstract

We have read with great interest the analysis by Meczker et al1Meczker Á. et al.Gastroenterology. 2020; 159: 1958-1962Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar reporting on 1060 patients with drug-induced acute pancreatitis (DIAP). The authors meticulously collected data from worldwide published case reports and case series of DIAP and compared them with a Hungarian cohort of 1225 patients with acute pancreatitis of any cause. Because case reports and case series are composed in retrospect, we were wondering why the authors did not consider data from published prospective cohort studies for their analysis, particularly because this was not explicitly excluded by the study design. A recent study2Rashidi M. et al.World J Gastroenterol. 2016; 22: 2104-2110Crossref PubMed Scopus (4) Google Scholar comparing identifiable causes of acute pancreatitis in a prospective and in a retrospective cohort concluded that patients who were prospectively characterized (a) undergo a more thorough investigation more often using ultrasonography and/or magnetic resonance imaging and (b) report a more detailed history of taking drugs possibly related to acute pancreatitis than patients who were retrospectively recruited. In the prospective group, more than one-half of the patients had ≥2 possible causes of pancreatitis, being mostly a combination of gallstones and drugs.2Rashidi M. et al.World J Gastroenterol. 2016; 22: 2104-2110Crossref PubMed Scopus (4) Google Scholar We, therefore, believe that a prospective study following a prespecified investigational protocol would allow a more precise patient characterization than retrospective data extracted from medical records. As recognized by the authors of the actual review in Gastroenterology,1Meczker Á. et al.Gastroenterology. 2020; 159: 1958-1962Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar the use of case reports and case series may be prone to publication bias. It seems indeed very likely that more often severe than mild disease courses of putative DIAP will be prepared for publication. To reinforce this argument, our previously published prospective multicenter cohort study on patients with inflammatory bowel disease treated with azathioprine3Teich N. et al.J Crohns Colitis. 2016; 10: 61-68Crossref PubMed Scopus (67) Google Scholar identified only mild courses of DIAP without any deaths,3Teich N. et al.J Crohns Colitis. 2016; 10: 61-68Crossref PubMed Scopus (67) Google Scholar as compared with only 69% mild courses and >8% DIAP-related deaths in the overall cohort by Meczker et al.1Meczker Á. et al.Gastroenterology. 2020; 159: 1958-1962Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Although the analysis of data from adverse event reporting systems4Nango D. et al.J Pharm Health Care Sci. 2019; 5: 5Crossref PubMed Google Scholar,5Niinomi I. et al.Int J Toxicol. 2019; 38: 487-492Crossref PubMed Scopus (8) Google Scholar may partially compensate for some of the limitations of collected case series, they are still susceptible to under-reporting, selective reporting, lack of information about total drug consumption, and many other inaccuracies. We, therefore, support the claim of others2Rashidi M. et al.World J Gastroenterol. 2016; 22: 2104-2110Crossref PubMed Scopus (4) Google Scholar that prospective studies should have an important role in furthering our knowledge of the role drugs play in the etiology of acute pancreatitis. Analysis of 1060 Cases of Drug-Induced Acute PancreatitisGastroenterologyVol. 159Issue 5PreviewAcute pancreatitis (AP) has a mortality of approximately 3%.1 Its reported incidence is variable across countries (10 to 100/100,000 inhabitants), and in the United States, AP is a significant cause of acute hospitalization for gastrointestinal disorders.2 Drug-induced AP (DIAP) is regarded as a rare and mild entity; yet, it is estimated to account for approximately 2% to 5% of AP episodes worldwide.3,4 Because DIAP has no unique features, rechallenge with the offending drug would be the only way to provide the most robust evidence to confirm the etiology. Full-Text PDF Open AccessReplyGastroenterologyVol. 160Issue 7PreviewWe are very grateful for the thoughts and comments on our study of 1060 cases of drug-induced acute pancreatitis (DIAP)1 by Teich et al. We found their concept so interesting and potentially useful that we decided to do a complementary study to identify all prospective studies on DIAP, reporting its severity and mortality, because our analysis included only case reports and case series. We aimed to determine the severity and mortality of DIAP in published data from prospective cohort studies on DIAP. Full-Text PDF