Pharmacological interventions for acute pancreatitis.

Area of Science:

• Gastroenterology and Hepatology
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• The role of medical interventions beyond supportive care in acute pancreatitis remains unclear.
• Supportive care includes fluid and electrolyte balance and organ support for organ failure.

Purpose of the Study:

• To evaluate the efficacy of various pharmacological interventions as adjuncts to supportive care in acute pancreatitis patients.
• To synthesize evidence from randomized controlled trials (RCTs) on the impact of medical treatments on acute pancreatitis outcomes.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, Science Citation Index Expanded) and trial registers was conducted up to October 2016.
• Inclusion criteria focused on RCTs in acute pancreatitis patients, regardless of etiology, severity, or infection status.
• Data extraction and analysis were performed by two independent reviewers; a fixed-effect and random-effects model were used for calculating odds ratios and rate ratios.

Main Results:

• Eighty-four RCTs involving 7366 participants were included. The risk of bias was generally high or unclear across most trials.
• No significant differences in short-term mortality were observed across any treatment comparisons (very low-quality evidence).
• Certain interventions showed potential reductions in serious adverse events (lexipafant, octreotide, somatostatin combinations), organ failure (octreotide), or sepsis (lexipafant), but evidence quality was low to very low.

Conclusions:

• Current very low-quality evidence indicates that pharmacological treatments do not decrease short-term mortality in acute pancreatitis.
• No consistent clinical benefits were identified for any intervention, and confidence intervals for mortality were wide.
• Future trials should include pancreatitis of all severities, focus on outcomes like complications and quality of life, and extend follow-up duration.