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A systematic review of NSAIDs treatment for acute pancreatitis in animal studies and clinical trials - 16/02/21

Doi : 10.1016/j.clirex.2019.100002 
Dong Wu a, Xiaoyin Bai a, Peter Lee b, Yingyun Yang a, John Windsor c, Jiaming Qian a,
a Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China 
b Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, PA, USA 
c Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Auckland, New Zealand 

Corresponding author.

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Highlights

This systematic review assessed the effect of therapeutic NSAID use in AP and its systemic complications based on preclinical and clinical studies.
We found that NSAIDs are effective in suppressing proinflammatory cytokines, relieving pain, ameliorating systematic complications and reducing mortality in both preclinical and clinical studies.
Serious adverse events associated with NSAIDs are rare. But the overall quality of current evidence is low.

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Abstract

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently given to patients with acute pancreatitis (AP) for controlling pain, but their efficacy in treating AP, particularly in reducing systemic complications, remains unclear.

Aim

The aim of our study was to evaluate the efficacy of NSAIDs in treating AP and its systematic complications.

Methods

Two independent reviewers screened articles from MEDLINE, Embase and Cochrane and scored the quality of each study according to the CAMARADES 10-item quality checklist or the Jadad scale. Five endpoints were chosen to evaluate the effect of NSAIDs in animal studies: amylase and lipase levels, proinflammatory cytokines, oxidative damage, histopathological changes, and mortality rate. Meanwhile, in clinical studies, endpoints, such as proinflammatory cytokines, pain relief, systematic complications, mortality, and adverse events were used.

Results

A total of 36 studies out of 17,845 were identified and included. Of these 36 studies, only 5 were clinical trials involving 580 patients, and the remaining 31 were animal studies with 1623 rats or mice. 24 studies focused on the treatment of AP with NSAIDs and 12 on AP-associated systematic complications. Both preclinical and clinical studies showed that NSAIDs may have beneficial effects against AP-related injuries. 9 of the 14 preclinical studies stated that NSAIDs reduced the serum amylase level significantly, and 6 of 7 showed that NSAIDs lowered the lipase level markedly. 17 experimental studies all demonstrated that NSAIDs reduced the inflammation. Histopathological examinations indicated that NSAIDs significantly improved the histopathological damages. Similarly, clinical evidence showed that NSAIDs are effective in suppressing proinflammatory cytokines, relieving pain, ameliorating systematic complications and reducing mortality. In the included 5 clinical studies, serious adverse events associated with NSAIDs were rarely reported.

Conclusion

This systematic review shows that NSAIDs are a potential treatment for AP-related injuries based on the current preclinical and clinical evidences.

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Keywords : Acute pancreatitis, AP systematic complication, Nonsteroidal anti-inflammatory drugs, Systematic review, Efficacy


Plan


 This article was originally published in Clinics and Research in Hepatology and Gastroenterology: X. Clinics and Research in Hepatology and Gastroenterology: X is now discontinued and the article is reprinted here for the reader's convenience. For citation purposes, please use the publication details of this article; Clinics and Research in Hepatology and Gastroenterology, 44S.


© 2019  Publié par Elsevier Masson SAS.
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Vol 44 - N° S

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