Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis

Statins exposure and acute pancreatitis: a retrospective cohort study using a large national insurance database

OBJECTIVES

The association between the use of statins and the incidence of acute pancreatitis (AP) has yielded inconsistent findings. While statins have been implicated as an aetiology for drug-induced pancreatitis, more recent studies have found statin use is associated with a reduced risk of pancreatitis. We sought to examine the association between the use of any statin medications and the risk of AP using large real-world data.

DESIGN

All data were collected retrospectively, but individuals were prospectively followed forward in time to determine the outcome of interest using International Classification of Diseases, 10th Revision, Clinical Modification codes indicating a diagnosis of AP. A stratified Cox proportional hazards regression model was conducted to examine the association of statins use with AP.

SETTINGS

Merative MarketScan claims database 2017-2020.

PARTICIPANTS

Individuals who filled any statin prescriptions with at least 80% proportion of days covered between 1 January 2017 and 31 December 2017 and were continuously enrolled in the database from 2016 to 2020. We also identified non-users of statins and constructed multiple strata of individuals based on the 14 confounders of interest.

RESULTS

Among 1 695 914 individuals, 226 314 had filled their statins prescription during the study period. Unadjusted incidence rates of AP generally showed higher rates among statins users. The unadjusted incidence rate and 95% CI per 1000 person-years of follow-up was 0.63 (95% CI: 0.61 to 0.66) for non-statin users, versus 0.92 (95% CI: 0.86 to 0.98) for statins users. However, a stratified Cox proportional hazards regression analysis yielded a HR of 0.92 (95% CI: 0.84 to 1.01) for statins users, indicating no difference between the two groups.

CONCLUSIONS

In this large real-world analysis, use of statins was not associated with a higher risk of AP in this US healthcare setting.

Pharmacological and Endoscopic Interventions for Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) represents the most common serious complication after endoscopic retrograde cholangiopancreatography (ERCP). Rectal non-steroidal anti-inflammatory drugs (NSAIDs) and pancreatic duct stenting (PDS) are the prophylactic interventions with more evidence and efficacy; however, PEP still represents a significant source of morbidity, mortality, and economic burden. Chronic statin use has been proposed as a prophylactic method that could be cheap and relatively safe. However, the evidence is conflicting. We aimed to evaluate the impact of endoscopic and pharmacological interventions including chronic statin and aspirin use, on the development of PEP.

Methods

A retrospective cohort study evaluated consecutive patients undergoing ERCP at John H. Stroger, Jr. Hospital of Cook County in Chicago from January 2015 to March 2018. Univariate and multivariate analyses were performed using logistic regression.

Results

A total of 681 ERCPs were included in the study. Twelve (1.76%) developed PEP. Univariate, multivariate, and subgroup analyses did not show any association between chronic statin or aspirin use and PEP. PDS and rectal indomethacin were protective in patients undergoing pancreatic duct injection. Pancreatic duct injection, female sex, and younger age were associated with a higher risk. History of papillotomy was associated with lower risk only in the univariate analysis (all P values < 0.05).

Conclusion

Chronic use of statins and aspirin appears to add no additional benefit to prevent ERCP pancreatitis. Rectal NSAIDs, and PDS after appropriate patient selection continue to be the main prophylactic measures. The lower incidence at our center compared with the reported data can be explained by the high rates of rectal indomethacin and PDS, the use of noninvasive diagnostic modalities for patient selection, and the expertise of the endoscopists.

Chronic use of statins and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis

BACKGROUND

There is limited evidence on the role of chronic statin therapy in the prevention of acute pancreatitis after ERCP. The aim of this meta-analysis was to evaluate the efficacy of statins in the prophylaxis of post-ERCP pancreatitis.

RESEARCH DESIGN AND METHODS

Bibliographic search was performed through May 2020. The primary outcome was post-ERCP pancreatitis rate. An additional endpoint was the rate of severe pancreatitis.

RESULTS

Nine studies, of which 1 prospective and 8 retrospective series, with 9374 patients were included. Baseline clinical and technical features were well balanced between the two study groups. Overall, pooled rate of post-ERCP pancreatitis was 4.8% (3.2%-6.4%) in the statin group and 7.1% (5.9%-8.3%) in the control group, with no difference in terms of pancreatitis rate (odds ratio 0.66, 95% confidence interval 0.43-1.02). This finding was confirmed in the multivariate analysis adjusted for several clinical and technical characteristics (adjusted odds ratio 0.68, 0.40-1.15). No difference was observed between the two study groups in terms of severe pancreatitis rate (odds ratio 1.07, 0.61-1.89).

CONCLUSIONS

Our meta-analysis seems to suggest the non-superiority of chronic statin therapy in preventing post-ERCP pancreatitis.