Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations
Identifieur interne : 000435 ( Main/Exploration ); précédent : 000434; suivant : 000436Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations
Auteurs : Dianna Wolfe [Canada] ; Salmaan Kanji [Canada] ; Fatemeh Yazdi [Canada] ; Pauline Barbeau [Canada] ; Danielle Rice [Canada] ; Andrew Beck [Canada] ; Claire Butler [Canada] ; Leila Esmaeilisaraji [Canada] ; Becky Skidmore [Canada] ; David Moher [Canada] ; Brian Hutton [Canada]Source :
- PLoS ONE [ 1932-6203 ] ; 2020.
Abstract
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.
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.
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.
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.
Url:
DOI: 10.1371/journal.pone.0231883
PubMed: 32302358
PubMed Central: 7164626
Affiliations:
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Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Kanji, Salmaan" sort="Kanji, Salmaan" uniqKey="Kanji S" first="Salmaan" last="Kanji">Salmaan Kanji</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yazdi, Fatemeh" sort="Yazdi, Fatemeh" uniqKey="Yazdi F" first="Fatemeh" last="Yazdi">Fatemeh Yazdi</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Barbeau, Pauline" sort="Barbeau, Pauline" uniqKey="Barbeau P" first="Pauline" last="Barbeau">Pauline Barbeau</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Rice, Danielle" sort="Rice, Danielle" uniqKey="Rice D" first="Danielle" last="Rice">Danielle Rice</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Beck, Andrew" sort="Beck, Andrew" uniqKey="Beck A" first="Andrew" last="Beck">Andrew Beck</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Butler, Claire" sort="Butler, Claire" uniqKey="Butler C" first="Claire" last="Butler">Claire Butler</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Esmaeilisaraji, Leila" sort="Esmaeilisaraji, Leila" uniqKey="Esmaeilisaraji L" first="Leila" last="Esmaeilisaraji">Leila Esmaeilisaraji</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Skidmore, Becky" sort="Skidmore, Becky" uniqKey="Skidmore B" first="Becky" last="Skidmore">Becky Skidmore</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Moher, David" sort="Moher, David" uniqKey="Moher D" first="David" last="Moher">David Moher</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Hutton, Brian" sort="Hutton, Brian" uniqKey="Hutton B" first="Brian" last="Hutton">Brian Hutton</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Objective</title><p>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.</p></sec><sec id="sec002"><title>Methods</title><p>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.</p></sec><sec id="sec003"><title>Results</title><p>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.</p></sec><sec id="sec004"><title>Discussion</title><p>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.</p></sec><sec id="sec005"><title>Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017060473">CRD42017060473</ext-link>.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Peery, Af" uniqKey="Peery A">AF Peery</name></author><author><name sortKey="Dellon, Es" uniqKey="Dellon E">ES Dellon</name></author><author><name sortKey="Lund, J" uniqKey="Lund J">J Lund</name></author><author><name sortKey="Crockett, Sd" uniqKey="Crockett S">SD Crockett</name></author><author><name sortKey="Mcgowan, Ce" uniqKey="Mcgowan C">CE McGowan</name></author><author><name sortKey="Bulsiewicz, Wj" uniqKey="Bulsiewicz W">WJ Bulsiewicz</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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