IDDF2019-ABS-0022 The efficacy of pentoxifylline on acute pancreatitis

Abstract

Background Acute pancreatitis is an inflammatory condition that occurs in the pancreatic parenchyma and systemically affect other organs. The first phase of the disease, usually during the first week, is caused by the patient‘s systemic inflammatory response elicited by acinar cell injury. During this phase, the severity of acute pancreatitis is directly related to extrapancreatic organ failure, and several intercellular signaling proteins such as tumor necrosis factor-a (TNF-a) are involved. Although there is currently no specific treatment for such condition, there is evidence in animals model showing that the administration of pentoxifylline, a competitive nonselective phosphodiesterase inhibitor, is able to reduce inflammation through TNF-a inhibition. However, its benefit in acute pancreatitis in human remains unclear. Subjects To study clinical outcomes of pentoxifylline in APACHE II score in acute pancreatitis patients at 72 hours after treatment and to study the effects of pentoxifylline on inflammatory markers level. Methods 54 acute pancreatitis patients with associated risk factors of severe pancreatitis development were evaluated for the severity of disease and inflammatory markers prior to treatment. Participants were allocated within 48 hours of diagnosis into pentoxifylline or control arm. The severity of disease, as well as inflammatory markers, were re-evaluated at 72 hours after treatment. Results Pentoxifylline did not decrease the severity of disease determined by a reduction in APACHE II score and a percent reduction of APACHE II compared with control group (0 Vs. 2; p-value = 0.27 and 0% reduction vs. 32% reduction; p-value =0.3, respectively). Interestingly, the incidence of the systemic inflammatory responds syndrome (SIRS) after 72 hours of treatment was significantly lower than those without pentoxifylline. (7.7% Vs. 29.2%; p-value = 0.048)(table 1.). Noticeably in subgroup analysis, patients who enrollment time less than 24 hours after onset of symptoms show mean proinflammatory marker tended to respond to pentoxifylline group better than the control group. Conclusions Pentoxifylline seems to reduce the inflammatory process of the early phase of acute pancreatitis, particularly in patients presented within 24 hours of onset. However, the overall severity of the disease and clinical benefit was similar to the control group.