Drug Induced Acute Pancreatitis: An Evidence Based Classification (Revised)

Saini, Jasmine; Marino, Daniel; Badalov, Nison; Vugelman, Melanie; Tenner, Scott

doi:10.14309/ctg.0000000000000621

Cited by 9 publications

(31 citation statements)

References 164 publications

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“…This, more restrictive, algorithm yielded only 9 events, all occurring in reference individuals, and thus, a hazard ratio could not be computed. We also note that Saini et al (4) recently published an article concluding that the purported AP-inducing effects of many medications rely on limited evidence. We agree that monitoring events after reintroduction of certain medications would be a worthwhile endeavor, but this was beyond the scope of our study.…”

mentioning

confidence: 82%

Response to Ma et al

Bergman,

Lindkvist,

Ludvigsson

2024

Am J Gastroenterol

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mentioning

confidence: 82%

Response to Ma et al

Bergman,

Lindkvist,

Ludvigsson

2024

Am J Gastroenterol

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“…According to the Agency for Drugs and Medical Devices Adverse Drug Event Reporting Database, drug-induced acute pancreatitis (DIAP) accounted for 0.17% of all adverse drug reactions (ADRs) [8]. Pharmacologic agents potentially responsible for acute pancreatitis include nearly 200 drugs [8,9]. However, causal relationships are largely based on case reports or case series with limited evidence.…”

Section: Drug-induced Pancreatitismentioning

confidence: 99%

“…Another key concept in determining the association between a particular drug and an adverse event is latency; latency is the time between the assumption of the drug and the occurrence of AP. Several systematic reviews use latency categories (e.g., <24 h, 1-30 days, >30 days), and if >75% of case reports for a drug fell into the same latency category, this was considered good evidence of an association (adequate latency) [9,11,12]. Currently, only three drugs have been associated with the development of AP in a randomized controlled trial (6-mercaptopurine, azathioprine, and didanosine) [9,[11][12][13].…”

Section: Drug-induced Pancreatitismentioning

confidence: 99%

Drug-Induced Acute Pancreatitis in Adults: Focus on Antimicrobial and Antiviral Drugs, a Narrative Review

Del Gaudio,

Covello,

Di Vincenzo

et al. 2023

Antibiotics

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Acute pancreatitis (AP) is an acute inflammation of the pancreas caused by the activation of digestive enzymes in the pancreatic tissue. The main causes of AP are cholelithiasis and alcohol abuse; less commonly, it can be caused by drugs, with a prevalence of up to 5%. Causal associations between drugs and pancreatitis are largely based on case reports or case series with limited evidence. We reviewed the available data on drug-induced AP, focusing on antimicrobial drugs and antivirals, and discussed the current evidence in relation to the classification systems available in the literature. We found 51 suspected associations between antimicrobial and antiviral drugs and AP. The drugs with the most evidence of correlation are didanosine, protease inhibitors, and metronidazole. In addition, other drugs have been described in case reports demonstrating positive rechallenge. However, there are major differences between the various classifications available, where the same drug being assigned to different probability classes. It is likely that the presence in multiple case reports of an association between acute pancreatitis and a drug should serve as a basis for conducting prospective randomized controlled trials to improve the quality of the evidence.

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“…Whereas some drugs, such as 6mercaptopurine, azathioprine, and didanosine clearly can cause AP, there are limited data supporting most medications as causative agents. A novel classification system recently published can assist clinicians in determining the level of evidence that a particular drug causes AP (34).…”

Section: Summary Of Evidencementioning

confidence: 99%

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

Tenner,

Vege,

Sheth

et al. 2023

Am J Gastroenterol

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Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.

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Drug Induced Acute Pancreatitis: An Evidence Based Classification (Revised)

Cited by 9 publications

References 164 publications

Response to Ma et al

Response to Ma et al

Drug-Induced Acute Pancreatitis in Adults: Focus on Antimicrobial and Antiviral Drugs, a Narrative Review

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis

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