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Wolfe D, Kanji S, Yazdi F, Barbeau P, Rice D, Beck A, Butler C, Esmaeilisaraji L, Skidmore B, Moher D, Hutton B. Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations. PLoS One 2020; 15:e0231883. [PMID: 32302358 PMCID: PMC7164626 DOI: 10.1371/journal.pone.0231883] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE A current assessment of case reports of possible drug-induced pancreatitis is needed. We systematically reviewed the case report literature to identify drugs with potential associations with acute pancreatitis and the burden of evidence supporting these associations. METHODS A protocol was developed a priori (PROSPERO CRD42017060473). We searched MEDLINE, Embase, the Cochrane Library, and additional sources to identify cases of drug-induced pancreatitis that met accepted diagnostic criteria of acute pancreatitis. Cases caused by multiple drugs or combination therapy were excluded. Established systematic review methods were used for screening and data extraction. A classification system for associated drugs was developed a priori based upon the number of cases, re-challenge, exclusion of non-drug causes of acute pancreatitis, and consistency of latency. RESULTS Seven-hundred and thirteen cases of potential drug-induced pancreatitis were identified, implicating 213 unique drugs. The evidence base was poor: exclusion of non-drug causes of acute pancreatitis was incomplete or poorly reported in all cases, 47% had at least one underlying condition predisposing to acute pancreatitis, and causality assessment was not conducted in 81%. Forty-five drugs (21%) were classified as having the highest level of evidence regarding their association with acute pancreatitis; causality was deemed to be probable or definite for 19 of these drugs (42%). Fifty-seven drugs (27%) had the lowest level of evidence regarding an association with acute pancreatitis, being implicated in single case reports, without exclusion of other causes of acute pancreatitis. DISCUSSION Much of the case report evidence upon which drug-induced pancreatitis associations are based is tenuous. A greater emphasis on exclusion of all non-drug causes of acute pancreatitis and on quality reporting would improve the evidence base. It should be recognized that reviews of case reports, are valuable scoping tools but have limited strength to establish drug-induced pancreatitis associations. REGISTRATION CRD42017060473.
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Affiliation(s)
- Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pauline Barbeau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Rice
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew Beck
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Butler
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Lu L, Lou Y, Tan H. Chemotherapy-induced fulminant acute pancreatitis in pancreatic carcinoma: A case report. Oncol Lett 2014; 8:1143-1146. [PMID: 25120674 PMCID: PMC4114602 DOI: 10.3892/ol.2014.2316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 05/23/2014] [Indexed: 11/05/2022] Open
Abstract
Cases of chemotherapy-induced pancreatitis are rarely reported and among those diagnosed, the majority are mild and self-limiting. However, no previous cases of fulminant acute pancreatitis (FAP) induced by chemotherapeutic agents have been reported. The current study presents a case of FAP in a 62-year-old female on gemcitabine and capecitabine therapy. The patient was admitted to the China-Japan Friendship Hospital (Beijing, China) with the symptoms of acute pancreatitis two days after the completion of the first cycle of chemotherapy. Shock, hypoxemia and acute renal failure supervened, which resulted in mortality. As the common etiologies of pancreatitis were eliminated, a correlation between the incidence of FAP, and pancreatic cancer or chemotherapy, or both was suspected. Clinicians should be aware of this potential adverse effect when prescribing chemotherapeutic agents, particularly in patients with pre-existing risk factors for pancreatitis.
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Affiliation(s)
- Linghui Lu
- Department of Traditional Chinese Medicine Oncology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yanni Lou
- Department of Traditional Chinese Medicine Oncology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Huangying Tan
- Department of Traditional Chinese Medicine Oncology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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Acute pancreatitis induced by ifosfamide therapy. J Pediatr Surg 2010; 45:2071-3. [PMID: 20920734 DOI: 10.1016/j.jpedsurg.2010.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/13/2010] [Accepted: 07/21/2010] [Indexed: 11/23/2022]
Abstract
Ifosfamide used in the treatment of pediatric solid tumors is known to have serious adverse effects, including acute pancreatitis, a rare complication of therapy. This report describes a young girl who developed acute pancreatitis while being treated for recurrent Wilms tumor with the ifosfamide, carboplatin, and etoposide regimen. She recovered completely and without sequelae from ifosfamide-induced pancreatitis soon after the drug was stopped. Abdominal pain in patients on anticancer treatment is a common occurrence, but it is rarely investigated. Patients who receive ifosfamide as part of a chemotherapy regimen should be carefully monitored, and symptoms or signs suggestive of acute pancreatitis should be promptly investigated. Withholding the drug usually leads to complete recovery.
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Experience of cancer care for metastasis-induced acute pancreatitis patients with lung cancer. J Thorac Oncol 2010; 4:1231-5. [PMID: 19692933 DOI: 10.1097/jto.0b013e3181b6b831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little information is available concerning the prognosis and treatment of metastasis-induced acute pancreatitis (MIAP) with lung cancer. The aim of this study was to investigate the prognostic factors of MIAP patients with lung cancer. METHODS A retrospective study of 20 MIAP patients with lung cancer was performed. Survival was estimated using Kaplan-Meier method. Prognostic factors were assessed with Cox proportional hazards regression model. RESULTS There were 14 men and six women; 15 cases were non-small cell lung cancer and five cases were small cell lung cancer. The median age was 68 (range, 41-83). The mean duration from lung cancer to MIAP diagnosis of having MIAP was 139.8 days (range, 3-892). However, two small cell lung cancer cases had preceded presentation with acute pancreatitis. Chemotherapy (p = 0.008; hazards ratio = 4.99; 95% confidence interval = 1.51-16.54) and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p = 0.007; hazards ratio = 6.13; 95% confidence interval = 0.04-0.61) were significant prognostic factors for survival. ECOG PS 3 to 4 at diagnosis of MIAP was 11/20. Survival of MIAP with lung cancer was 108.7 days. Patients with ECOG PS 3 to 4 had shorter mean survival than those with PS 0 to 2 (33.7 versus 226.4 days; p = 0.003). Chemotherapy group had longer mean survival than those without chemotherapy (161.9 versus 25.0 days; p = 0.01). CONCLUSION Chemotherapy can improve survival of MIAP from bronchogenic carcinoma in the selected patients.
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Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol 2007; 5:648-61; quiz 644. [PMID: 17395548 DOI: 10.1016/j.cgh.2006.11.023] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.
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Affiliation(s)
- Nison Badalov
- Division of Gastroenterology, Maimonides Medical Center, Mount Sinai School of Medicine, Brooklyn, New York 11235, USA
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Abstract
Acute pancreatitis is a rare complication during chemotherapy for pediatric patients with solid tumors. We report a 9-year-old boy with osteosarcoma who experienced 2 episodes of pancreatitis 1 day and 48 days after infusion of ifosfamide (IFOS), respectively. From a MEDLINE search, this is the 3rd reported case and 2nd reported pediatric case of IFOS-induced pancreatitis, and only this case experienced late-onset pancreatitis.
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Affiliation(s)
- Miao-Chiu Hung
- Department of Pediatrics, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
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Abstract
Ifosfamide is a bifunctional alkylating agent, used as a racemic mixture by intravenous route in the treatment of various tumors. It is an oxazaphosphorine derivative with a structural formula similar to that of cyclophosphamide. As a prodrug it requires activation in the liver by a cytochrome mixed-function oxidase system. Among various metabolites, ifosforamide mustard probably represents the most important cytotoxic compound able to produce irreparable cross-links between DNA strands. Resistance is due to the ability of neoplastic cells to repair DNA damages. Acrolein may induce hemorrhagic cystitis, whereas chloroacetaldehyde may be responsible both for nephro- and neurotoxicity. A thiol donor (mesna) can prevent urotoxic effects but not nephro- and neurotoxicity. Pharmacokinetics is markedly influenced by route of administration and duration of treatment, age, co-medication, liver and renal function.
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Affiliation(s)
- M Furlanut
- Institute of Clinical Pharmacology and Toxicology, University of Udine, Udine, Italy.
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