Corticosteroid treatment for acute/acute-on-chronic experimental and naturally occurring pancreatitis in several species: a scoping review to inform possible use in dogs

Abstract

Acute pancreatitis in dogs is a prevalent disease characterised by mild to severe inflammation. Treatment with anti-inflammatory corticosteroids has been widely debated but is not generally recommended in veterinary medicine. The objective of the present study was to present current evidence on the effect of corticosteroid treatment for acute/acute-on-chronic pancreatitis across species. These findings were then used to evaluate if and how corticosteroid treatment could influence disease outcome in canine acute/acute-on-chronic pancreatitis. A scoping review was performed by searching the Agricola, CAB Abstracts, MEDLINE and Embase databases to identify relevant articles published before June 24, 2021. The inclusion criteria were English language, original research published in a peer-reviewed journal, and investigation of corticosteroid treatment effects on acute/acute-on-chronic pancreatitis by the outcome parameters clinical score, circulating CRP level, hospitalisation duration, mortality and pancreas histopathology. Research on any species was considered. Studies were rated based on the level of evidence, and methodological quality was evaluated based on similarity between groups at baseline, risk of bias and study group size. The reporting method was based on the PRISMA extension for scoping reviews. One thousand nine hundred fifty-four studies were identified, and 31 met the inclusion criteria. Five were canine studies, with 4 investigating experimentally induced pancreatitis; 5 were human clinical studies; and 21 were rodent studies of experimentally induced pancreatitis. The level of evidence ranged between randomised controlled trials and case series, the estimated risk of bias ranged from low to high, and the sample sizes ranged from very small to moderate. Evidence indicates that adding corticosteroid to symptomatic treatment of acute/acute-on-chronic canine pancreatitis could have a positive influence on disease outcome. However, the analysed evidence was based on several species, including both naturally occurring and experimentally induced pancreatitis; thus, the authors suggest that large randomised controlled studies should be performed in dogs with spontaneously occurring acute/acute-on-chronic pancreatitis to further elucidate a potential benefit of corticosteroid treatment.

New insights into the etiology, risk factors, and pathogenesis of pancreatitis in dogs: Potential impacts on clinical practice

“…75 A recent review, evaluating data from multiple species, suggested that corticosteroids might have a positive effect on outcome in the treatment of acute or acute on chronic pancreatitis in dogs. 76 Several early studies documented a potential relationship between organophosphates and the development of AP. Sublethal doses of organophosphate anticholinesterase ex vivo results in AP in dogs as determined by histopathology.…”

Utility of 1,2‐o‐dilauryl‐rac‐glycero glutaric acid‐(6′‐methylresorufin)‐ester‐lipase for monitoring dogs with chronic pancreatitis

“…4,10,41,43 Immune-mediated CP is reported in cocker spaniel and Cavalier King Charles spaniel breeds in the United Kingdom 5,44 and administrating glucocorticoids or cyclosporine is reported in dogs and cats with CP and AP to suppress inflammation. 45,46 Immunosuppressive therapy was not associated with the clinical score or with serum DGGR-lipase activity changes (either improved or worsened) herein;…”

“…Immune‐mediated CP is reported in cocker spaniel and Cavalier King Charles spaniel breeds in the United Kingdom 5,44 and administrating glucocorticoids or cyclosporine is reported in dogs and cats with CP and AP to suppress inflammation 45,46 . Immunosuppressive therapy was not associated with the clinical score or with serum DGGR‐lipase activity changes (either improved or worsened) herein; nevertheless, these results should be interpreted cautiously.…”

Risk Factors and Clinical Presentation in Dogs with Increased Serum Pancreatic Lipase Concentrations—A Descriptive Analysis

“…Administration of corticosteroids to healthy dogs does not result in significant changes in cPLI concentrations or does not commonly (1/6) increase serum cPLI concentrations into a diagnostic range for pancreatitis [ 38 , 39 ]. Indeed, corticosteroids are now being used with increasing frequency in the management of acute pancreatitis [ 40 , 41 ]. In contrast with those results, our study showed a moderate frequency of corticosteroid use prior to sampling in dogs with increased Spec cPL concentrations, and this may reflect the presence of concurrent disease treated with corticosteroids or secondary pancreatic inflammation influenced by concurrent disease [ 8 ].…”