1
|
Masarweh OM, Al-Moussally F, Meruvia Garron JP, Kunadia A, Karasik O, Asmar A. A Fatal Case of Lisinopril-Induced Acute Necrotizing Pancreatitis. Cureus 2023; 15:e40071. [PMID: 37304386 PMCID: PMC10250023 DOI: 10.7759/cureus.40071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACE-I), such as lisinopril, are used as first-line therapy in the treatment of hypertension, heart failure with reduced ejection fraction, and proteinuric chronic kidney disease due to their beneficial effects on reducing morbidity and mortality. Commonly cited adverse effects of lisinopril include hyperkalemia, acute kidney injury, and angioedema, and while uncommon, there have been reports of lisinopril-induced necrotizing pancreatitis in the literature. The true incidence of drug-induced pancreatitis is unknown since establishing a causal relationship between medication's adverse effects and disease occurrence is difficult; however, there are validated tools such as the Adverse Drug Reaction Probability Scale that can aid in determining causality. Here, we present a case of a 63-year-old man with a history of hypertension who was being treated with lisinopril for eight months and developed a fatal case of lisinopril-induced severe necrotizing pancreatitis.
Collapse
Affiliation(s)
- Omar M Masarweh
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Feras Al-Moussally
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Anuj Kunadia
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Olga Karasik
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Abdo Asmar
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| |
Collapse
|
2
|
Zhang L, Mao W, Li X, Wang X, Liu J, Hu S, Hu J. Analysis of acute pancreatitis associated with SGLT-2 inhibitors and predictive factors of the death risk: Based on food and drug administration adverse event report system database. Front Pharmacol 2022; 13:977582. [PMID: 36467046 PMCID: PMC9716078 DOI: 10.3389/fphar.2022.977582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/31/2022] [Indexed: 08/24/2023] Open
Abstract
Background and objectives: The US FDA and Health Canada have successively published potential red flags for acute pancreatitis caused by sodium-dependent glucose transporter 2 inhibitors (SGLT-2i). However, existing studies have focused on case reports. We aimed to assess the possible association of SGLT-2i with acute pancreatitis by analyzing postmarketing adverse events reported in the FDA adverse event reporting system (FAERS), to explore risk factors for SGLT-2i-related acute pancreatitis death, and to build a nomogram. Methods and Results: We used a disproportionality analysis of suspected acute pancreatitis-related reports in the FAERS database of patients from the use of SGLT-2i from the first quarter of 2013 to the fourth quarter of 2021. Single-factor and multi-factor logistic regression analyses were performed using the relevant clinical information of patients, and risk factors were combined with the age of patients to construct a SGLT-2i risk prediction model for acute pancreatitis-related death. A total of 757 reports were retrieved. The largest number of acute pancreatitis-related cases were caused by canagliflozin (317 reports), which was also the strongest agent associated with acute pancreatitis, with the information component (IC 2.41, lower 95% one-sided confidence interval 2.16), the reporting odds ratio (ROR 5.37, 95% two-sided confidence interval 4.8-5.99), and the empirical Bayesian geometric mean (EBGM 5.32, lower 90% one-sided confidence interval 4.85). The median time to acute pancreatitis was 54 (interquartile range [IQR] 14-131) days, and approximately 83% of adverse events occurred within 6 months. Odds ratio(OR) adjusted by acute pancreatitis and the coadministration of SGLT-2i with dipeptidyl peptidase 4 inhibitor (DPP-4i), glucagon-like peptide 1 analog (GLP-1RA), and angiotensin converting enzyme inhibitor (ACEIs) was 1.39, 1.97, and 1.34, respectively, all of which were statistically significant. Logistic regression analysis showed that different SGLT-2i type and their combinations with statins were independent risk factors for acute pancreatitis mortality in the patients (p < 0.05). The mortality risk prediction model showed good discrimination and clinical applicability in both the training set (AUC 0.708) and the validation set (AUC 0.732). Conclusion: SGLT-2i may increase the risk of acute pancreatitis especially within the first 6 months of drug administration. Combination with DPP-4i, GLP-1RA or ACEIs significantly increases the risk of acute pancreatitis. In addition, different SGLT-2i type and their combination with statins are risk factors that can predict the risk of death following acute pancreatitis.
Collapse
Affiliation(s)
- Lin Zhang
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Mao
- Department of Pharmacy, Nanan People’s Hospital of Chongqing, Chongqing, China
| | - Xingxing Li
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaowen Wang
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jifang Liu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Sang Hu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Hu
- Department of Pharmacy, Southwest Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
3
|
Sosnowski K, Nehring P, Przybyłkowski A. Pancreas and Adverse Drug Reactions: A Literature Review. Drug Saf 2022; 45:929-939. [PMID: 35788538 DOI: 10.1007/s40264-022-01204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
Adverse drug reactions (ADRs) affecting the pancreas are a heterogeneous group of side effects that cause damage to pancreatic cells. Various mechanisms such as hypersensitization, sphincter of Oddi constriction, direct cytotoxic and metabolic effects on pancreatic cells, and dose-dependent idiosyncrasy lead to intrapancreatic activation of pancreatic enzymes resulting in drug-induced acute pancreatitis. Several medications have been linked with the development of pancreatic cancer. Pancreatic cancer may result from proinflammatory, proliferative, and antiapoptotic effects. Diabetogenic effect of drugs, which is understood as impairment of insulin secretion, may occur due to direct destruction of β cells, systemic toxicity affecting pancreatic islets and cell membrane glucose transporters, induction of Th1-type autoimmune response, and impairment of voltage-gated calcium channels in β cells, endoplasmic reticulum stress, and insulin signaling. A better understanding of ADRs that affect the pancreas may contribute to improving the awareness of clinicians and patients and reducing potential harmful side effects of implemented therapies.
Collapse
Affiliation(s)
- Konrad Sosnowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Nehring
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
| |
Collapse
|
4
|
Baum J, Walfish A, Fenster M, Miller Y, Kresch M. Another Case of Lisinopril-Induced Acute Pancreatitis. Cureus 2021; 13:e19488. [PMID: 34912629 PMCID: PMC8664365 DOI: 10.7759/cureus.19488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Lisinopril as a cause for acute drug-induced pancreatitis is an emerging phenomenon that due to its generally low-risk profile often goes unnoticed. The true incidence of drug-induced pancreatitis is unknown, probably because of its nonrecognition among differential diagnosis. Only a handful of lisinopril-induced pancreatitis has been discussed in the literature, and little epidemiological evidence exists to establish true causality. Additionally, many of these reports have been met with skepticism claiming that it is difficult to isolate a true cause since many of these patients had comorbidities or were concomitantly taking other medications that may have contributed to the pancreatitis. Here, we report a case in which a generally otherwise healthy patient presented with acute drug-induced pancreatitis caused by an angiotensin-converting enzyme (ACE) inhibitor taken eight weeks prior to the onset of symptoms. The drug was immediately stopped, and the patient recovered well, with no complications.
Collapse
Affiliation(s)
- Jeffrey Baum
- Surgery, New York Medical College, New York, USA
| | - Aaron Walfish
- Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, USA
| | - Moshe Fenster
- Internal Medicine, Westchester Medical Center, New York, USA
| | - Yair Miller
- Anesthesia, New York Medical College, New York, USA
| | - Mindy Kresch
- Dermatology, New York Medical College, New York, USA
| |
Collapse
|
5
|
Rouette J, Yin H, McDonald EG, Barkun A, Azoulay L. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Acute Pancreatitis: A Population-Based Cohort Study. Drug Saf 2021; 45:65-74. [PMID: 34714528 DOI: 10.1007/s40264-021-01128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There are conflicting reports on the effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on acute pancreatitis incidence. OBJECTIVE The aim was to determine whether use of ACE inhibitors and ARBs is associated with the incidence of acute pancreatitis, compared with use of dihydropyridine calcium channel blockers (dCCBs). METHODS We assembled two population-based, new-user, active comparator cohorts using the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository and Office for National Statistics from 1998 to 2018, with follow-up until 2019. The first cohort included 304,083 ACE inhibitor initiators and 194,431 dCCB initiators. The second cohort included 29,160 ARB initiators and 203,610 dCCB initiators. Cox proportional hazards models were fit to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of acute pancreatitis, comparing ACE inhibitors and ARBs, separately, with dCCBs. Models were weighted using standardized mortality ratio weights generated from calendar time-specific propensity scores. RESULTS ACE inhibitors were associated with an increased risk of acute pancreatitis, compared with dCCBs (64.3 vs 45.2 per 100,000 person-years, respectively; HR 1.45, 95% CI 1.15-1.83). The number needed to harm after 2 and 5 years of use was 2438 and 1019, respectively. In contrast, ARBs were not associated with an increased risk of acute pancreatitis, compared with dCCBs (40.1 vs 47.6 per 100,000 person-years, respectively; HR 0.88, 95% CI 0.60-1.31). CONCLUSIONS ACE inhibitors were associated with a modest increased risk of acute pancreatitis compared with dCCBs. This association should be balanced with the known clinical benefits of ACE inhibitors in hypertension management. In contrast, no association was observed with ARBs.
Collapse
Affiliation(s)
- Julie Rouette
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, QC, H3T 1E2, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hui Yin
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, QC, H3T 1E2, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.,Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Laurent Azoulay
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.
| |
Collapse
|