Azathioprine-induced Acute Pancreatitis in Patients with Inflammatory Bowel Diseases--A Prospective Study on Incidence and Severity.

Abstract

BACKGROUND AND AIMS:

Azathioprine [AZA] is recommended for maintenance of steroid-free remission in inflammatory bowel disease IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.

METHODS:

We studied 510 IBD patients [338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis] with initiation of AZA treatment in a prospective multicentre registry study. Acute pancreatitis was diagnosed in accordance with international guidelines.

RESULTS:

AZA was continued by 324 [63.5%] and stopped by 186 [36.5%] patients. The most common cause of discontinuation was nausea [12.2%]. AZA-induced pancreatitis occurred in 37 patients [7.3%]. Of these: 43% were hospitalised with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections; 24% had vomiting; and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis [p < 0.0002] in univariate and multivariate analyses.

CONCLUSIONS:

AZA-induced acute pancreatitis is a common adverse event in IBD patients, but in this study had a mild course in all patients. Smoking is the most important risk factor.

• Authors: Niels Teich, Wolfgang Mohl, Bernd Bokemeyer, Burkhard Bündgens, Jürgen Büning, Stephan Miehlke, Dietrich Hüppe, Christian Maaser, Tobias Klugmann, Wolfgang Kruis, Britta Siegmund, Ulf Helwig, Joseph Weismüller, Attyla Drabik, Andreas Stallmach, German IBD Study Group
• Journal: Journal of Crohn's & colitis (J Crohns Colitis) Vol. 10 Issue 1 Pg. 61-8 (Jan 2016) ISSN: 1876-4479 [Electronic] England
• PMID: 26468141 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © European Crohn’s and Colitis Organistion (ECCO) 2015.

Chemical References

• Azathioprine

Topics

• Acute Disease
• Adult
• Age Distribution
• Aged
• Analysis of Variance
• Azathioprine (administration & dosage, adverse effects)
• Colitis, Ulcerative (drug therapy, pathology)
• Crohn Disease (drug therapy, pathology)
• Female
• Germany
• Humans
• Incidence
• Inflammatory Bowel Diseases (drug therapy, pathology)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Pancreatic Function Tests
• Pancreatitis (chemically induced, epidemiology, physiopathology)
• Prognosis
• Prospective Studies
• Registries
• Risk Assessment
• Severity of Illness Index
• Sex Distribution