Quantifying the Risk of Drug-Induced Pancreatitis With Angiotensin-Converting Enzyme Inhibitors and Statins Using a Large Electronic Medical Record Database

Abstract

Objectives: Quantify the risk of drug-induced pancreatitis (DIP) from angiotensin-converting enzyme inhibitors (ACEis) and 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins).Methods: Retrospective cohort analysis using IBM Explorys (1999-2019), a pooled, deidentified clinical database of more than 63 million patients across the United States. Odds ratios were calculated to determine the risk of DIP from ACEi, statins, and both medications together. χ 2 testing assessed the relationship between age, sex, ethnicity, insurance status, and mortality among patients with DIP from ACEi, statins, or both combined.Results: Acute pancreatitis (AP) was found in 280,740 patients. Odds ratios for ACEi, statins, and both combined were 6.12, 4.97, and 5.72, respectively. Thirty-eight percent of all-cause AP occurs in adults older than 65 years. Acute pancreatitis from ACEi and statins occurs in 49% and 56% of patients older than 65 years, respectively. Men and patients older than 65 years are at higher risk of DIP from ACEi and statins. Patients on Medicaid are at higher risk of DIP from statins, and Asian patients are at highest risk of DIP from ACEi. Conclusions:We found that ACEi and statins increase the odds of DIP.Although ACEis and statins are critical medications for many patients, clinicians should consider using alternatives in patients with AP of unclear etiology.

Statins exposure and acute pancreatitis: a retrospective cohort study using a large national insurance database

“…However, this study did not account for comorbidities and confounders to the extent performed in our analysis. 18 Conversely, a meta-analysis of observational studies including 13 studies with nearly 35 000 patients with AP and over 5 million controls found a prevalence of statin use of 9.8% among patients with AP versus 25% among controls. 7 Another meta-analysis by Preiss and colleagues using randomised controlled trials with cardiovascular endpoints including 16 studies and nearly 114 000 participants found that statin use was associated with a lower risk of patients with normal or mildly elevated triglyceride levels.…”

Drug-Induced Acute Pancreatitis - Literature Overview and Our Experience

“…označila za nejčastější příčinu polékové akutní pankreatitidy sulfonamidy, kyselinu valproovou a nesteroidní antirevmatika (15). Z celosvětově často preskribovaných léků nutno dále vzpomenout ACE inhibitory, které samostatně, případně i v kombinaci se statinem, zvyšují riziko zejména u pacientů nad 65 let a u mužů (16). Dále je popsané riziko polékové akutní pankreatitidy u hormonální antikoncepce a hormonální substituční léčby, diuretik (furosemid, hydrochlorotiazid), antivirotik (inhibitory proteáz), antidiabetik (inkretiny, inhibitory DPP-4) a aminosalicylátů (7 krát vyšší riziko u mesalazinu než u sulfasalazinu, popsaná je i akutní pankreatitida po rektální aplikaci klysmatu) (9,17).…”