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2014 ; 14
(ä): 102
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Treatment of acute pancreatitis with protease inhibitors administered through
intravenous infusion: an updated systematic review and meta-analysis
#MMPMID24886242
Seta T
; Noguchi Y
; Shikata S
; Nakayama T
BMC Gastroenterol
2014[May]; 14
(ä): 102
PMID24886242
show ga
BACKGROUND: The intravenous use of protease inhibitors in patients with acute
pancreatitis is still controversial. The purpose of this study was to evaluate
the effectiveness of protease inhibitors intravenously administered to prevent
pancreatitis-associated complications. METHODS: We updated our previous
meta-analysis with articles of randomized controlled trials published from
January 1965 to March 2013 on the effectiveness of protease inhibitors for acute
pancreatitis. A systematic search of PubMed, EMBASE, the Cochrane Library, and
Japana Centra Revuo Medicina was conducted. In addition, Internet-based
registries (ClinicalTrials.gov, controlled-trials.com, UMIN, JMACCT, and JAPIC)
were used to search for on-going clinical trials. Furthermore, references of
review articles and previously published meta-analyses were handsearched. The
main outcome of interest was the overall mortality rate from acute pancreatitis.
RESULTS: Seventeen trials were selected for analysis. Overall, protease
inhibitors did not achieve a significant risk reduction in mortality (pooled risk
difference [RD], -0.02; 95% Confidence Interval [CI], -0.05 to 0.01; number
needed to treat [NNT], 74.8) with low heterogeneity. A subgroup analysis in
moderate to severe pancreatitis (defined by control mortality rate [CMR] >0.10)
did not show a significant effect of protease inhibitors to prevent death (pooled
RD, -0.03; 95% CI, -0.07 to 0.01; NNT, 1603.9) with low heterogeneity. An
additional subgroup analysis of two trials with CMR >0.20 (i.e., low quality)
revealed a significant risk reduction. CONCLUSION: The present meta-analysis
re-confirmed that there is no solid evidence that supports the intravenous use of
protease inhibitors to prevent death due to acute pancreatitis.
|Acute Disease
[MESH]
|Aprotinin/therapeutic use
[MESH]
|Gabexate/therapeutic use
[MESH]
|Humans
[MESH]
|Infusions, Intravenous
[MESH]
|Pancreatitis/*drug therapy/mortality
[MESH]
|Protease Inhibitors/*therapeutic use
[MESH]
|Serine Proteinase Inhibitors/therapeutic use
[MESH]