title: Effect of tumor necrosis factor-α inhibitors on drug-induced pancreatitis in inflammatory bowel disease.
abstract: BACKGROUND
  Mesalamine and thiopurines (6-mercaptopurine and azathioprine) have been shown to increase the risk of developing acute pancreatitis in inflammatory bowel disease (IBD) patients. Tumor necrosis factor-α (TNF-α) inhibitors have been shown to protect against pancreatitis in animal models.
  
  
  OBJECTIVE
  To determine the risk of pancreatitis when comparing thiopurine monotherapy, mesalamine monotherapy, and thiopurine and mesalamine dual therapy to identical treatments but with the addition of a TNF-α inhibitor.
  
  
  METHODS
  Using a case-control design, the Food and Drug Administration Adverse Event Reporting System was queried for cases of pancreatitis and control reactions in IBD patients on a thiopurine or mesalamine. The proportional reporting ratio method was used to compare the different therapy regimens with the same regimen combined with a TNF-α inhibitor.
  
  
  RESULTS
  In all, 549 cases and controls were identified. When comparing thiopurine monotherapy with thiopurines combined with a TNF-α inhibitor, the odds of pancreatitis were lower in those on combination therapy (odds ratio [OR] = 0.04; 95% CI = 0.01-0.12). A similar trend was seen when comparing mesalamine monotherapy to mesalamine combined with a TNF-α inhibitor (OR = 0.08; 95% CI = 0.04-0.14) and when comparing those on both a thiopurine and mesalamine with those on all 3 therapies (OR = 0.04; 95% CI = 0.01-0.16).
  
  
  CONCLUSIONS
  Combination therapy with TNF-α inhibitors appears to be associated with a lower risk of pancreatitis in IBD patients on mesalamine, thiopurines, or a combination of both. Physicians should consider using TNF-α inhibitors in those with the greatest risk of pancreatitis, although prospective studies are needed.
authors: NorthShore University HealthSystem, Evanston, IL, USA djstobaugh@gmail.com.
authors: Derrick J
authors: DJ
authors: Stobaugh
authors: Mayo Clinic, Rochester, MN, USA.
authors: Parakkal
authors: P
authors: Deepak
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001379:Azathioprine / Q000009:adverse effects*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D019804:Mesalamine / Q000009:adverse effects*; D008875:Middle Aged; D016017:Odds Ratio; D010195:Pancreatitis / Q000139:chemically induced*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine; D015122:Mercaptopurine; D001379:Azathioprine
keywords: 6-mercaptopurine; drug-related side effects and adverse reactions; inflammatory bowel diseases; mesalamine; pancreatitis; tumor necrosis factor