COX-2 Inhibitors Help Prevent Severe Acute Pancreatitis

By Anne Harding

March 05, 2020

NEW YORK (Reuters Health) - Cyclooxygenase-2 (COX-2)-inhibitor treatment reduces severe acute pancreatitis (SAP) by nearly half in at-risk patients, according to a new randomized controlled trial.

Besides offering organ support, COX-2 inhibitors "effectively block the inflammatory cascade during the development of severe acute pancreatitis," Drs. Libin Huang, Zhiyin Huang and Chengwei Tang of West China Hospital and Sichuan University in Chengdu, China, told Reuters Health in a joint email. "This regimen presented good cost-effectiveness.”

Predicted SAP progresses to SAP 70% to 80% of the time, Dr. Huang and colleagues note in the American Journal of Gastroenterology. Based on experimental evidence showing overexpression of COX-2 in acute pancreatitis, and that blocking COX-2 reduced pancreatitis severity, the authors conducted a randomized trial in which 190 patients with predicted SAP received standard treatment or standard treatment plus 40 mg per day of parecoxib intravenously for three days, followed by 200 mg of celecoxib orally or through a feeding tube every day for one week.

SAP developed in 21% of the COX-2 group compared to 40% of the conventional treatment group (P=0.005). A similar percentage of patients in both groups developed organ failure, but it was more likely to be transient in the COX-2 group. The mortality rate was also similar for the two groups.

At enrollment, all patients had above-normal serum levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). TNF-alpha and IL-6 were reduced in both groups at day 4 and day 8 of the study, but the reduction was greater in the COX-2 group. There were no serious adverse events.

Two-thirds of the conventional treatment group required meperidine injections, compared to about 43% of the COX-2 group. Mean hospital stay and hospital costs were also lower with COX-2 inhibitors (21 days vs. 13 days, 36,271 yuan vs. 26,853 yuan, respectively).

"There were some limitations in this clinical trial," the researchers note in their report. "The lack of placebo to attain double blinding may affect the pain scoring system since it is a patient-reported outcome. Being open and conducted in a single center, there might be some data bias."

The team is now organizing a larger multicenter clinical trial to verify the efficacy and safety of COX-2 for preventing SAP.

The trial had no funding, and the authors report no conflicts of interest.

SOURCE: American Journal of Gastroenterology, February 3, 2020.