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Prevention of Severe Acute Pancreatitis With Cyclooxygenase-2 Inhibitors: A Randomized Controlled Clinical Trial
Zhiyin Huang1,2, Xiao Ma2, Xintong Jia2
1Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
Objectives:
Severe acute pancreatitis (SAP) is still a big challenge. Accumulated data showed that overexpression of cyclooxygenase-2 (COX-2) in acute pancreatitis and experimental pancreatitis could be attenuated with COX-2 inhibitors. This study was aimed to evaluate whether the occurrence of SAP could be prevented by selective COX-2 inhibitors.
Methods:
A total of 190 patients with predicted SAP were randomized into convention group or convention plus COX-2 inhibitors (C+COX-2-Is) group. Besides conventional treatment to all patients in 2 groups, parecoxib (40 mg/d intravenous injection for 3 days) and celecoxib (200 mg oral or tube feeding twice daily for 7 days) were sequentially administrated to the patients in the C+COX-2-Is group. The primary outcome was predefined as the occurrence of SAP. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) for all of the patients were measured.
Results:
The occurrence of SAP in the C+COX-2-Is group was decreased 47.08% compared with the convention group, 21.05% (20/95) vs 39.78% (37/93), P = 0.005. A reduction of late local complications was also shown in the C+COX-2-Is group, 18.95% (18/93) vs 34.41% (32/95), P = 0.016. The serum levels of IL-6 and TNF-α were significantly lower in the C+COX-2-Is group than those in the convention group, P < 0.05. Parecoxib relieved abdominal pain more rapidly and decreased the consumption of meperidine. An incremental reduction of cost for 1% decrease of SAP occurrence was RMB475.
Discussion:
Sequential administration of parecoxib and celecoxib in patients with predicted SAP obtained about half-reduction of SAP occurrence through decreasing serum levels of TNF-α and IL-6. This regimen presented good cost-effectiveness.
Insights
Selective cyclooxygenase-2 (COX-2) inhibitors, parecoxib and celecoxib, significantly reduced severe acute pancreatitis (SAP) occurrence and complications. This COX-2 inhibitor regimen offers a cost-effective strategy for preventing SAP by lowering inflammatory markers.
Area of Science:
- Gastroenterology
- Pharmacology
- Clinical Medicine
Background:
- Severe acute pancreatitis (SAP) poses a significant clinical challenge.
- Overexpression of cyclooxygenase-2 (COX-2) is observed in acute pancreatitis.
- COX-2 inhibitors have shown potential in attenuating pancreatitis in experimental models.
Purpose of the Study:
- To evaluate the efficacy of selective COX-2 inhibitors in preventing the occurrence of SAP.
- To assess the impact of COX-2 inhibitors on inflammatory markers and complications in patients with predicted SAP.
Main Methods:
- A randomized controlled trial involving 190 patients with predicted SAP.
- Patients were assigned to conventional treatment or conventional treatment plus sequential COX-2 inhibitors (parecoxib and celecoxib).
- Primary outcome was SAP occurrence; secondary outcomes included local complications, serum IL-6 and TNF-α levels, pain relief, and cost-effectiveness.
Main Results:
- The incidence of SAP was significantly reduced by 47.08% in the COX-2 inhibitor group (21.05% vs 39.78%, P = 0.005).
- Late local complications decreased by 45.1% in the COX-2 inhibitor group (18.95% vs 34.41%, P = 0.016).
- Serum levels of IL-6 and TNF-α were significantly lower, and parecoxib provided faster pain relief with reduced meperidine consumption.
Conclusions:
- Sequential administration of parecoxib and celecoxib effectively reduces SAP occurrence and complications.
- This regimen lowers key inflammatory markers, including TNF-α and IL-6.
- The COX-2 inhibitor approach demonstrates good cost-effectiveness for SAP prevention.
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