Drug-Induced Acute Pancreatitis Cases Notified to the CNPV

• Published in: Drug safety 2022-10, Vol.45 (10), p.1247-1248
• Main Authors: Aouinti, I, Mahjoubi, Y, Zgolli, F, Belgacem, M B, Jabri, F E, Dabbech, S, Aidli, S E, Daghfous, R
• Format: Article
• Language: English
• Subjects: Anti-inflammatory agents; Antibiotics; Antihypertensives; Azathioprine; Captopril; Collating; Complications; Drugs; Etiology; GLP-1 receptor agonists; Glucocorticoids; Immunosuppressive agents; Inflammation; Intestine; Medical personnel; Pancreatitis; Patients; Pharmacology; Pharmacovigilance; Sex ratio; Young adults
• ISSN: 0114-5916; 1179-1942

Introduction: The incidence of acute pancreatitis (AP) varies between 15 to 40 cases/ 100,000/year [1]. Drugs are responsible for 2% of acute pancreatitis cases [2]. In Tunisia, few studies have been carried out on drug induced pancreatitis [3]. Objective: To analyze the clinical characteristics of DIAP cases notified to the Chalbi Belkahia National Center for Pharmacovigilance (CNPV) and identify incriminated drugs. Methods: Retrospective study carried out in the department of collection and analysis of adverse reactions over 22 years from 1997 to 2018 collating the cases of DIAP notified to the CNPV. We included cases meeting the diagnostic criteria of AP [4] and whose drug imputation was retained by the pharmacovigilance investigation evaluated according to the French method of Begaud et al [5]. Results: We collected 41 cases in which 48 drugs (33 active ingredients) were incriminated. The median age of the patients was 42.3 years (15 to 78 years). The sex ratio F/H was 1.05. The notifying physicians were gastrologists in 34% and surgeons in 27% of cases. Chronic pathologies were present in 37/41 patients where IBD represents 27% of cases. Scannographic stage was B in 27% of cases. Stages D and E were found in 27% of cases. The onset delay varied from one day to 12 years. In 46% of the cases, it was more than one month. Immunosuppressants, antihypertensive, and intestinal anti-inflammatory drugs were incriminated in 12% of cases each, followed by glucocorticoids and antibiotics (10% of cases each). Among the immunosuppressants, azathioprine was found in 12% of cases. Among antihypertensive drugs, captopril was incriminated in 7% of cases. The drug-induced pancreatitis cases were mostly moderate with a favorable outcome after discontinuation of the drug in 98% of cases. Positive re-challenge occurred in one case with captopril. The imputation score was plausible (I2) in 51% of cases. Conclusion: Our study showed a predominance of DIAP in young adults with a slight female predominance. The delay of onset is essentially more than 1 month with a favorable evolution in almost all cases. The incriminated drugs belonged essentially to the classes of immunosuppressants, antihypertensives, and intestinal anti-inflammatories. Up-to-date knowledge of drugs that can cause PA can help clinicians be aware of this infrequent etiology and facilitate rapid discontinuation of the causative agent, thus reducing complications.