Meta-analysis of somatostatin, octreotide and gabexate mesilate in the therapy of acute pancreatitis.
BACKGROUND
Autodigestion of the pancreas, secondary to the activation of digestive enzymes, is the pathogenetic mechanism of acute pancreatitis (AP).


OBJECTIVE
Clinical trials in which somatostatin (SS), octreotide (OCT) and gabexate mesilate (FOY) were used to treat patients with AP, were submitted to a meta-analytical evaluation. Five end-points were evaluated: early and overall mortality, patients with complications, complication rate, and patients who needed surgery.


RESULTS
In mild AP, no agent proved of value. In severe AP, both SS and OCT were beneficial in improving the overall mortality: the odds ratios (OR) were, respectively, 0.36 (95% CI: 0.20-0.64, P = 0.001) and 0.57 (95% CI: 0.35-0.88, P = 0.006). FOY had no effect on either early or overall mortality, but was effective in improving complication rate (OR = 0.70, 95% CI: 0.56-0.88, P = 0.02), number of patients with complications (OR = 0.61, 95% CI: 0.41-0.91, P = 0.01), and number of cases submitted to surgery (OR = 0.60, 95% CI: 0.39-0.92, P = 0.01). SS and OCT had no effect on these latter outcomes.


CONCLUSIONS
Antisecretory agents, such as SS and OCT, are able to reduce mortality without affecting complications, whereas antiproteases, such as FOY, have no effect on mortality but do reduce complications. A trial exploring the efficacy of combining antisecretory agents with antiproteases would be of great benefit in patients with severe AP.
Andriulli
A
A
Division of Gastroenterology, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, Italy.
Leandro
G
G
Clemente
R
R
Festa
V
V
Caruso
N
N
Annese
V
V
Lezzi
G
G
Lichino
E
E
Bruno
F
F
Perri
F
F
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016670:Gabexate / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D010195:Pancreatitis / Q000188:drug therapy*; D013004:Somatostatin / Q000627:therapeutic use*; D013223:Statistics as Topic; D016896:Treatment Outcome
D000925:Anticoagulants; D006727:Hormone Antagonists; D006728:Hormones; D016670:Gabexate; D013004:Somatostatin; D015282:Octreotide