title: Association of oral glucocorticoid use with an increased risk of acute pancreatitis: a population-based nested case-control study.
abstract: OBJECTIVE
  Oral glucocorticoid use has been suggested to cause acute pancreatitis in several case reports. However, no epidemiological study has investigated this association.
  
  
  OBJECTIVE
  To conduct a nationwide population-based case-control study to investigate the potential association between oral glucocorticoid use and acute pancreatitis.
  
  
  METHODS
  In this population-based case-control study, all individuals aged 40 to 84 years who developed a first episode of acute pancreatitis between 2006 and 2008 in Sweden were identified.
  
  
  METHODS
  Population-based, nationwide, register-based study.
  
  
  METHODS
  A total of 6161 cases with a first episode of acute pancreatitis and 61,637 controls were included in the final analyses. Cases were all patients diagnosed as having a first episode of acute pancreatitis during the study period, defined by the diagnosis code K85 in the International Statistical Classification of Diseases, 10th Revision (ICD-10). Controls were randomly selected from the source population at risk of developing acute pancreatitis. For each case, 10 controls, matched for age, sex, and calendar period, were randomly selected from the general population. Oral glucocorticoid use was assessed from the Swedish Prescribed Drug Register. Current, recent, and former users were defined as patients who collected their glucocorticoid prescription within 30, 31 to 180, and after 180 days before the index date, respectively.
  
  
  METHODS
  Unconditional logistic regression was performed to calculate the odds ratios (ORs) with 95% confidence intervals for the association between oral glucocorticoid use and acute pancreatitis. Multivariable adjustment was made for potential confounders including, among others, alcohol abuse, diabetes, and concomitant drug use.
  
  
  RESULTS
  The study included 6161 cases of acute pancreatitis and 61,637 controls. The risk of acute pancreatitis was increased among current users of oral glucocorticoids compared with nonusers (OR, 1.53; 95% CI, 1.27-1.84). This risk was highest 4 to 14 days after drug dispensation (OR, 1.73; 95% CI, 1.31-2.28) and attenuated thereafter. There was no association between oral glucocorticoid use and acute pancreatitis immediately after drug dispensation. There was no increased risk of acute pancreatitis among recent or former users of glucocorticoids compared with nonusers.
  
  
  CONCLUSIONS
  Current oral glucocorticoid use is associated with an increased risk of acute pancreatitis.
authors: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, SE-171 76 Stockholm, Sweden. omid.azodi@ki.se
authors: Omid
authors: O
authors: Sadr-Azodi
authors: Fredrik
authors: F
authors: Mattsson
authors: Tomas Sjöberg
authors: TS
authors: Bexlius
authors: Mats
authors: M
authors: Lindblad
authors: Jesper
authors: J
authors: Lagergren
authors: Rickard
authors: R
authors: Ljung
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010195:Pancreatitis / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D005938:Glucocorticoids