Discrepancies between population-based data and adverse reaction reports in assessing drugs as causes of acute pancreatitis.
BACKGROUND
Many drugs are believed, clinically, to cause acute pancreatitis. We used information held on the UK General Practitioner Research Database to compare risks for drugs for which reports of pancreatitis were common or uncommon.


METHODS
Drug prescriptions were examined in 3673 patients with acute pancreatitis and in matched controls. Odds ratios were calculated for recent (1-90 days before the episode), past (91-360 days before the episode) or continuing (prescription in both periods) use.


RESULTS
Odds ratios were markedly increased for recent antisecretory use in non-ulcer patients only [all H2-antagonists, 12.4 (9.5-16.4); all proton pump antagonists, 9.3 (6.6-13.0)], with smaller increases for past [3.1 (2.5-3.7) and 3.5 (2.6-4.6), respectively] and continuing [2.6 (2.2-3.1) and 3.7 (2.9-4.7), respectively] use in patients without ulcer. Recent users of mesalazine showed a markedly increased risk [9.0 (1.8-44.6)], with smaller increases in past and continuing users [4.5 (1.3-16.0) and 2.5 (1.2-5.0), respectively]. Odds ratios for other drugs, suspect or not, were modestly increased, irrespective of whether the use was recent, past or continuing. The presence of gall-stones was not associated with a modified risk.


CONCLUSIONS
Mesalazine, azathioprine and antisecretory drugs in non-ulcer subjects may increase the risk of pancreatitis, but warnings of drug-induced pancreatitis are generally not accompanied by increased population risks.
Lancashire
R J
RJ
Department of Epidemiology and Public Health, University of Birmingham, Edgbaston, Birmingham, UK.
Cheng
K
K
Langman
M J S
MJ
D000208:Acute Disease; D016907:Adverse Drug Reaction Reporting Systems; D000998:Antiviral Agents / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000009:adverse effects; D002491:Central Nervous System Agents / Q000009:adverse effects; D005765:Gastrointestinal Agents / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016015:Logistic Models; D016017:Odds Ratio; D010195:Pancreatitis / Q000139:chemically induced*; D011159:Population Surveillance; D012044:Regression Analysis; D012307:Risk Factors
D000998:Antiviral Agents; D002317:Cardiovascular Agents; D002491:Central Nervous System Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents