Hypertriglyceridemia-Associated Drug-induced Acute Pancreatitis

Abstract

Introduction: Drug-induced acute pancreatitis (DIAP) is a rare cause of acute pancreatitis. More than 100 drugs have been implicated as the cause of acute pancreatitis and different mechanisms of injury have been proposed. The aim of our study was to investigate the cases of DIAP with hypertriglyceridemia as the mechanism of injury. Methods: A MEDLINE search (1963-2018) of the English language literature was performed looking for all adults (>18 years old) human case reports with hypertriglyceridemia as the mechanism of DIAP. All published case reports were reviewed by 2 physicians. The included reports were required to provide the name of the drug and the diagnosis of acute pancreatitis (AP) must have been established strictly based on the revised Atlanta classification criteria Search revealed total of 71 cases in 60 cases reports, implicating 25 drugs. Drugs were classified into probability groups based on a classification used by Badalov et al. Class Ia drugs included drugs with at least 1 case report with positive rechallenge, excluding all other causes, such as alcohol, gallstones, and other drugs. Class Ib drug, included drugs with at least 1 case report with positive rechallenge; however, other causes, were not ruled out. Class II drugs, included drugs that had at least 2 cases in the literature with consistent latency. Class III drugs, included at least 2 cases in the literature with no consistent latency among cases and no rechallenge. Class IV drugs, included drugs not fitting into the earlier described classes, single case report published in medical literature, without rechallenge. Latencies were classified to short (latency of < 24 hours), intermediate (latency of 1-30 days), and long (latency >30 days). Eight cases in 5 case reports that did not fulfill the above study inclusion criteria and were excluded. Results: A total of 25 medications were found to be implicated in DIAP secondary to hypertriglyceridemia mechanism. Most of acute pancreatitis cases were mild or moderately severe with favorable outcomes. In 3 cases involving Tamoxifen, Pagaspargase and Quetiapine, patient death was the outcome. In efforts of decreasing triglyceride levels, plasmapheresis was only used in 9 cases Conclusion: Hypertriglyceridemia associated DIAP is a rare phenomenon and the current systematic review provides a summary of drugs that have been implicated in this phenomenon, which allow physicians to be oriented about this side effect when these drugs are used.106 Figure 1. Classification of Culprit drugs