Azathioprine-induced acute pancreatitis in patients with inflammatory bowel diseases - a prospective study on incidence and severity

Teich N, Mohl W, Bokemeyer B, Bündgens B, Büning J, Miehlke S, Hüppe D, Maaser C, Klugmann T, Kruis W, Siegmund B, Helwig U, Weismüller J, Drabik A, Stallmach A; German IBD Study Group*. J Crohns Colitis. 2015 Oct 13. pii: jjv188. [Epub ahead of print]

BACKGROUND AND AIMS: Azathioprine (AZA) is recommended for maintenance of steroid-free remission in 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 multicenter 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 hospitalized with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections, 24% had to vomit 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 had a mild course in all patients. Smoking is the most important risk factor.

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