Prior statin use and the outcomes in patients with first-attack acute pancreatitis: A retrospective cohort study

Simvastatin in the Prevention of Recurrent Pancreatitis: Design and Rationale of a Multicenter Triple-Blind Randomized Controlled Trial, the SIMBA Trial

Background: One in every four patients with a first episode of non-gallstone-related acute pancreatitis (AP) develops recurrent disease. Recurrent episodes of AP or acute flares of chronic pancreatitis (CP) are associated with decreased quality of life and progression of the disease. Besides removing the etiology of pancreatitis (which sometimes is not possible), there are no effective measures to prevent recurrence. Meta-analyses of randomized controlled trials, as well as epidemiological and cohort studies, suggest that statins may be protective against the development of index AP. Methods: The SIMBA study is a triple-blind randomized placebo-controlled, parallel-group multicenter trial. Patients with recurrent AP or with acute flares of CP (at least two episodes in the last 12 months) will be randomized to receive simvastatin 40 mg daily or placebo. During a 3-year study period, 144 patients (72 per arm of treatment) from 26 centers will be enrolled. The patients will receive the study treatment for 1 year. The primary aim is to compare the recurrence of AP or acute flares in CP. Secondary endpoints include the incidence of new-onset diabetes mellitus, new-onset exocrine pancreatic insufficiency (EPI), new-onset imaging signs of CP, frequency of all-cause hospital admissions, severity of AP, adherence to treatment, and frequency of adverse events. Discussion: The SIMBA trial will ascertain whether simvastatin, a safe, widely used and inexpensive drug, can change the natural course of recurrent pancreatitis. Trial Registration: ClinicalTrials.gov Identifier: NCT04021498.

Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis

BACKGROUND

The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Statin consumption seems to lower the incidence of acute pancreatitis. We aimed to investigate the relationship between the use of statins and the incidence of PEP.

METHODS

multicenter (4 Spanish tertiary-level public hospitals) retrospective cohort study. Adult patients undergoing an ERCP were included in the study. We excluded patients with chronic pancreatitis, with ongoing acute pancreatitis and those who developed other complications after ERCP. Patients were classified into 2 groups: those under statin treatment (group S) and controls (group C). A multivariate analysis was performed (binary logistic regression) including age, center, female gender, previous pancreatitis, suspected sphincter of Oddi dysfunction, difficult cannulation (>10 min), >1 pancreatic guidewire passages, pancreatic injection, pancreatic stenting and presence of choledocholitiasis.

RESULTS

seven hundred and two patients were included, median age 74 (62-82 years), 330 (47%) females, 223 (32%) in group S. Thirty-five (5%) patients developed PEP, 6 (3%) in group S and 29 (6%) in group C. Statin use was not associated with a lower frequency of PEP in univariate analysis, OR 0.429 (95% confidence interval 0.176-1.05, p = 0.06) or in multivariate analysis, adjusted OR 0.5 (0.19-1.32), p = 0.16. Statin use had no effect on severity of PEP, being mild in 50% vs 78.6% in non-statin users, p = 0.306.

CONCLUSIONS

the chronic use of statins was not associated with a decreased risk of PEP or a milder course of disease in our sample of patients.

Reduced risk of post ERCP pancreatitis in statin users

Background

One of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of 3.5 to 15%, is post ERCP pancreatitis (PEP). Given the role of statins in the reduction of systemic and pancreatic intraluminal inflammation, we hypothesized that the use of statins may lower the risk of PEP.

Methods

A retrospective cohort study of all patients undergoing ERCP at West Virginia University during the years 2016 and 2017 was performed. Possible association of collected variables with PEP was assessed with Univariate tests and multivariable logistic regression analyses.

Results

A total of 1162 ERCPs were included. Mean age was 60.12 years (SD: 17.5). 51.3% of the participants were female. Two hundred and sixty-three participants underwent more than one ERCP during the study period.

Seven hundred and ninety-nine ERCPs (78.8%) were conducted in participants who were not taking a statin medication at the time of ERCP, while 363 participants were on statin medications at the time of ERCP; 118 and 245 participants were taking high dose statins (atorvastatin 40–80 mg or rosuvastatin 20 mg), and low/medium dose statins (all other statin regimens) at the time of the procedure, respectively.

The overall incidence of PEP in the cohort was 7.3%. In the non-statin and statin groups, 9.5 and 3.4% of participants developed PEP, respectively. On univariate analysis, young age, no statin use, history of PEP, and endoscopic sphincterotomy were found to be significantly associated with the development of PEP. In a binary logistic regression model, young age (P = 0.033), history of PEP (P = 0.0001, OR 2.41, 95% CI: 1.05–5.51) and endoscopic sphincterotomy (P = 0.038, OR 2.85, 95% CI: 1.7–4.78) were found to be associated with increased risk of PEP. Statin usage was found to be protective against PEP, (OR 0.35, 95% CI: 0.18–0.69).

Conclusion

Chronic statin usage is protective against post ERCP pancreatitis, and our findings suggest a potential role of these drugs as prophylactic agents. Randomized controlled trials are needed to establish any potential clinical application.

Statin intake can decrease acute pancreatitis severit

BACKGROUND/OBJECTIVES

Acute Pancreatitis (AP) is one of the leading gastrointestinal conditions requiring hospitalization. It has been suggested that statins could exert a protective role in the natural history of AP; however, their influence is not entirely clear. Our objective was to investigate the relationship between statin intake and AP.

METHODS

Retrospective analysis of a prospective registry of patients diagnosed with AP. Statin intake on admission as well as clinical, analytical, demographic and radiological data were recorded.

OUTCOME PARAMETERS

Severity of AP, SIRS development, organ failure, local complications, intensive care admission, collection drainage, hospital length of admission, and death. Univariate and multivariate analyses as well as a propensity score logistic regression were conducted.

RESULTS

From March 2014-October 2018 we studied 356 patients. 101 patients (28%) were taking statins. 55 (15%) suffered from moderate/severe pancreatitis. Multivariate analysis showed a 50% less risk of suffering from moderate/severe AP (OR 0.50 95% CI 0.22-1.0, p 0.50) and 33% less risk of developing local complications (OR 0.33 95%CI 0.15-0.80, p 0.014) among statin consumers, with a tendency towards less SIRS. Propensity score analysis confirmed that patients on statins suffering from AP had a lower risk to have a moderate/severe episode (OR 0.409 95%CI 0.192-0.872, p 0.031), to develop local complications (OR 0.47 95%CI 0.20-1.06, p 0.11) and SIRS (OR 0.516 95% CI 0.28-0.93, p 0.041).

CONCLUSIONS

Patients taking statins who suffer from an episode of AP are more likely to follow a mild course and have a lower risk of developing local complications and SIRS.

Association of Statins With Decreased Acute Pancreatitis Severity: A Propensity Score Analysis

BACKGROUND

Statins possess anti-inflammatory properties and have a protective effect in certain inflammatory conditions; however, their effect on the natural history of pancreatitis is unknown.

AIM

The aim of this study is to assess the effect of statin exposure on the severity of pancreatitis and incidence of organ failure using a propensity-matched approach.

METHODS

A historical cohort study was conducted of adult patients with acute pancreatitis (AP) admitted in the Cleveland Clinic Health System between 2007 and 2014. All medication, clinical, and outcomes data were extracted from the electronic medical record. Factors that influence statin use were included in a propensity model to minimize selection bias. Patients on and off statins were matched (1:1) based on the propensity score to simulate a randomized controlled trial. Measured outcomes included pancreatitis severity (Revised Atlanta Classification), incidence of multisystem organ failure (MSOF), new MSOF, acute necrosis, and death. Additional surrogate markers of severity included hospital length of stay, Bedside Index of Severity of Acute Pancreatitis (BISAP), and presence of SIRS.

RESULTS

A total of 110 subjects taking a statin at admission were matched with 210 subjects not on a statin. Known baseline factors that may influence statin use and severity of pancreatitis were evenly matched between the 2 groups. Patients on a statin were less likely to develop MSOF, severe AP and necrosis. Although less in-hospital death occurred in the statin group when compared to nonusers, the difference was not statistically significant (2% vs. 4%; P=0.38).

CONCLUSIONS

Statin use is associated with decreased severity of AP observed as reduction in both overall MSOF incidence and new MSOF. Prospective randomized controlled trials are needed to determine the efficacy of statin drugs in the treatment of AP.

Chronic Use of Statins and Their Effect on Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background and Aims: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the major complications of ERCP. Thus, several non-invasive as well as invasive strategies have been investigated as preventative therapies for PEP with various efficacy. Methods: We enrolled any patients who underwent ERCP both at the Shaare Zedek Medical Center in Jerusalem and EMMS Nazareth hospital. Association between use of statins and different variables were assessed with univariate tests (chi-squared for categorical variables). Predictors of incidence of PEP and severity of pancreatitis were computed using conditional logistic regression, correcting for potential confounding factors. Results: 958 subjects were analyzed. Average age was 62.04 ± 21.18 years (median 68 years). Most of the patients were female (n = 558, 58.2%), Jewish (n = 827, 86.3%), and inpatients (n = 631, 65.9%). Only few ERCPs were performed emergently (n = 40, 4.2%). Twenty-Seven patients repeated the exam. Overall incidence of PEP/hyperamylasemia was 16.8% (n = 161); with a 5.6% (n = 54) incidence of hyperamylasemia and a 11.2% (n = 107) incidence of pancreatitis. Overall, 6 cases of severe pancreatitis were identified. The logistic regression analysis demonstrated that chronic use of statins is a protective factor in preventing development of PEP/hyperamylasemia [OR 0.436 [95%CI 0.303-0.627], p < 0.001]; Particularly, the PEP OR was of 0.318 [95%CI 0.169-0.597], p < 0.001 and the hyperamylasemia OR was of 0.565 [95%CI 0.372-0.859], p = 0.008. No significant predictor could be found for the risk of developing severe PEP. Conclusions: Our data support the possibility of exploiting statins as preventive agents for PEP. However, further studies, mainly RCTs, are warranted in order to replicate our findings.

Statin use is not associated with an increased risk of acute pancreatitis-A meta-analysis of observational studies

Background

Statins are perceived as potential etiological factors for acute pancreatitis (AP), but recent evidence suggests the opposite. Our aim was to evaluate the association between statin use and risk of AP in observational studies.

Methods

Medline, Scopus, and Web of Science were searched for cohort (C) and case-control (CC) studies evaluating statins as intervention and AP as outcome. Pooled adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated.

Results

Thirteen studies (seven CC, six C) with 34,899 AP patients and 5,377,894 controls were included. Prevalence of statin use was 9.8% among AP patients and 25% among controls. Pooled adjusted OR was 1.00 (95% CI = 0.63 to 1.59) with considerable heterogeneity (I ²= 98%). CC studies were associated with increased AP risk (OR = 1.33; 95% CI = 1.20 to 1.47), unlike C studies (OR = 0.69; 95% CI = 0.37 to 1.31). No association with increased risk was found for studies from Western countries (OR = 0.90; 95% CI = 0.52 to 1.56), unlike for studies conducted in Asia (OR = 1.39; 95% CI = 1.10 to 1.75).

Conclusion

Statin use is not associated with increased risk of AP. Increased risk was limited to CC studies, which are more prone to bias, while C studies showed no global effect. Further research is needed to clarify whether statin type, dosage, treatment duration or AP etiology might account for this difference.