Treatment of acute pancreatitis with protease inhibitors: a meta-analysis.
OBJECTIVE
Protease inhibitors are used to treat acute pancreatitis, but their effectiveness remains unclear. We performed a meta-analysis to determine whether treatment with protease inhibitors reduces overall mortality or morbidity from acute pancreatitis.


METHODS
Articles of randomized controlled trials evaluating effects of protease inhibitors for acute pancreatitis were retrieved by systematically searching Medline, the Cochrane Library and Journal@ovid databases published from January 1966 through December 2003. References of review articles were also searched manually. The main outcome in interest was the overall mortality rate from acute pancreatitis.


RESULTS
Ten studies met the inclusion criteria. Treatment with protease inhibitors did not significantly reduce the mortality rate from acute pancreatitis (pooled risk difference, -0.03; 95% confidence interval, -0.07 to 0.01). Subgroup analyses showed that treatment with protease inhibitors significantly reduced the mortality rate in patients with moderate to severe pancreatitis (pooled risk difference, -0.07; 95% confidence interval, -0.13 to -0.01) as defined by mortality rate in the control group (control mortality rate > 0.10). The decrease in mortality rate was not significant in mild pancreatitis (pooled risk difference, 0.00; 95% confidence interval, -0.04 to 0.05).


CONCLUSIONS
Treatment with protease inhibitors does not significantly reduce the mortality in patients with acute or mild pancreatitis, but may reduce the mortality in patients with moderate to severe pancreatitis.
Seta
Takeshi
T
Department of Gastroenterology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan.
Noguchi
Yoshinori
Y
Shimada
Toshihiko
T
Shikata
Satoru
S
Fukui
Tsuguya
T
D018784:Abdominal Abscess / Q000209:etiology; D000208:Acute Disease; D007611:Aprotinin / Q000627:therapeutic use; D016670:Gabexate / Q000627:therapeutic use; D006801:Humans; D010192:Pancreatic Pseudocyst / Q000209:etiology; D010195:Pancreatitis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011480:Protease Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D011480:Protease Inhibitors; D015842:Serine Proteinase Inhibitors; D016670:Gabexate; D007611:Aprotinin