[Acute pancreatitis induced by drugs derived from 5-aminosalicylic acid: case report and review of the literature].
The pancreatic toxicity of oral 5-aminosalicylic acid (5ASA) derivatives used for the treatment of inflammatory bowel diseases remains controversial. A new case of mesalazine-induced acute pancreatitis (AP), with positive rechallenge, and an analysis of the previous published cases are presented. Twenty-nine patients (17 women, 12 men), aged 26.4 +/- 9.9 (12-43) years, were involved, receiving sulfasalazine (n = 11), mesalazine (n = 16), olsalazine (n = 1) or 5ASA without further informations (n = 1), for ulcerative colitis (n = 15), Crohn's disease (n = 13) or another indication (n = 1). The AP occurred in the first month of treatment in 71.4 per cent of the cases (n = 28). The clinical course was essentially benign in most of the cases. Recurrence of AP after rechallenge was observed in 17 of the 19 cases, even if the molecule, the dose or the form were modified. These results show that all 5ASA derivatives are potentially pancreatotoxic. An AP must be considered when an occurrence or increase of abdominal pain occurs during such therapy and warrants serum amylase assay and discontinuation of the drug.
Decocq
G
G
Centre régional de Pharmacovigilance, Hôpital Sud, CHU, Amiens, France.
Gras-Champel
V
V
Vrolant-Mille
C
C
Delcenserie
R
R
Sauvé
L
L
Masson
H
H
Andréjak
M
M
D000208:Acute Disease; D000328:Adult; D000636:Aminosalicylic Acids / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000009:adverse effects*; D010195:Pancreatitis / Q000139:chemically induced*
D000636:Aminosalicylic Acids; D019804:Mesalamine