Pentoxifylline Treatment in Severe Acute Pancreatitis: A Pilot, Double-Blind, Placebo-Controlled, Randomized Trial

Vege, Santhi Swaroop; Atwal, Tegpal; Bi, Yan; Chari, Suresh T.; Clemens, Magdalen A.; Enders, Felicity

doi:10.1053/j.gastro.2015.04.019

Cited by 39 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty-three articles (21 articles containing patients suffering from SAP as well as 12 articles with MAP patients) were selected. They contained two nonrandomized and 31 randomized controlled clinical trials (Table 2) [16][17][18][19][20][21][22][23][24][25][26][27]29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Finally, statistical analyses were performed on data from articles where both EN and NPO groups were presented, the trial was randomized, and the relevant data were available.…”

Section: Inclusions and Exclusionsmentioning

confidence: 99%

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

2017

View full text Add to dashboard Cite

Abstract:The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-Whitney U test was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.

show abstract

Section: Inclusions and Exclusionsmentioning

confidence: 99%

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

2017

View full text Add to dashboard Cite

show abstract

“…Interventional studies have targeted patients with predicted severe pancreatitis [1–4]. However, predicted severe pancreatitis has protean definitions ranging from various APACHE scores to C-reactive protein levels to clinical findings, such as abnormal chest roentgenography.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, diversity of inclusion criterion makes it challenging to identify which groups of patients benefit from specific therapy. Additionally, while objective acute pancreatitis outcomes such as death are fortunately rare this necessitates the use of surrogate measures such as clinical improvement or changes in cytokine levels as study endpoints [1, 5]. The use of scoring systems that predict severity of disease have predominated in the acute pancreatitis field.…”

Section: Introductionmentioning

confidence: 99%

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Buxbaum

Quezada

Chong

et al. 2018

American Journal of Gastroenterology

View full text Add to dashboard Cite

OBJECTIVES: The Pancreatitis Activity Scoring System (PASS) has been derived by an international group of experts via a modified Delphi process. Our aim was to perform an external validation study to assess for concordance of the PASS score with high face validity clinical outcomes and determine specific meaningful thresholds to assist in application of this scoring system in a large prospectively ascertained cohort. METHODS: We analyzed data from a prospective cohort study of consecutive patients admitted to the Los Angeles County Hospital between March 2015 and March 2017. Patients were identified using an emergency department paging system and electronic alert system. Comprehensive characterization included substance use history, pancreatitis etiology, biochemical profile, and detailed clinical course. We calculated the PASS score at admission, discharge, and at 12 h increments during the hospitalization. We performed several analyses to assess the relationship between the PASS score and outcomes at various points during hospitalization as well as following discharge. Using multivariable logistic regression analysis, we assessed the relationship between admission PASS score and risk of severe pancreatitis. PASS score performance was compared to established systems used to predict severe pancreatitis. Additional inpatient outcomes assessed included local complications, length of stay, development of systemic inflammatory response syndrome (SIRS), and intensive care unit (ICU) admission. We also assessed whether the PASS score at discharge was associated with early readmission (re-hospitalization for pancreatitis symptoms and complications within 30 days of discharge). RESULTS: A total of 439 patients were enrolled, their mean age was 42 (±15) years, and 53% were male. Admission PASS score >140 was associated with moderately severe and severe pancreatitis (OR 3.5 [95% CI 2.0, 6.3]), ICU admission (OR 4.9 [2.5, 9.4]), local complications (3.0 [1.6, 5.7]), and development of SIRS (OR 2.9 [1.8, 4.5]) as well as prolongation of hospitalization by a mean of 1.5 (1.3–1.7) days. For the prediction of moderately severe/severe pancreatitis, the PASS score (AUC = 0.71) was comparable to the more established Ranson’s (AUC = 0.63), Glasgow (AUC = 0.72), Panc3 (AUC = 0.57), and HAPS (AUC = 0.54) scoring systems. Discharge PASS score >60 was associated with early readmission (OR 5.0 [2.4, 10.7]). CONCLUSIONS: The PASS score is associated with important clinical outcomes in acute pancreatitis. The ability of the score to forecast important clinical events at different points in the disease course suggests that it is a valid measure of activity in patients with acute pancreatitis.

show abstract

“…In a double-blinded randomized control trial, Vege et al found that use of pentoxi llyne, an inhibitor of tumor necrosis factor in patients with predicted severe acute pancreatitis, was associated with fewer ICU admissions and lower duration of hospitalization 10 . In their study, although serum TNF-a, CRP, interleukin-1 and interleukin-6 levels decreased more in pentoxi llyne group, the reduction was not statistically signi cant, which may be due to the small sample size (14 in each group).…”

Section: Discussionmentioning

confidence: 99%

Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized, Controlled Clinical Trial

Shahbazi

Shariatpanahi

Shahbazi

2020

Preprint

View full text Add to dashboard Cite

Background: We evaluated effect of ketorolac on reducing the severity of acute pancreatitis.Methods: Fifty six adult patients, with predicted severe acute pancreatitis were randomly divided into two groups. The patients in the study group received intravenous ketorolac, 10 mg, 3 times daily from time of enrollment for a maximum of 5 days as needed along with standard medical treatment. Primary outcome measure was the change in the serum level of hs-CRP. Patients were also followed up in terms of hospitalization duration, need for ICU care, development of organ failure, persistent organ failure, pancreatic necrosis, nutritional assessment and mortality. The study was continued to gather clinical follow up information up to 4 months.Results: Serum level of hs-CRP was significantly lower in the ketorolac group than in the control group on days 3, 4, and 5. Organ failure, pseudocyst formation, acute necrotic collection and intensive care unit transfer occurred non-significantly more in the control group than in the ketorolac group. Median days of hospitalization were significantly lower in the study group than in the control group. Based on the Log rank test, survival within 4 months was marginally lower in the control group (P=0.076). The time to start feeding was significantly shorter in the study group than in the control group with no need to artificial enteral nutrition in the ketorolac group. Frequency of NPO (not per oral) was significantly lower in the ketorolac group.Conclusion: The use of ketorolac may improve feeding and clinical outcomes in severe acute pancreatitis.ClinicalTrials.gov: NCT02885441, Date: August 31, 2016

show abstract

Pentoxifylline Treatment in Severe Acute Pancreatitis: A Pilot, Double-Blind, Placebo-Controlled, Randomized Trial

Cited by 39 publications

References 12 publications

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized, Controlled Clinical Trial

Contact Info

Product

Resources

About