COX-2 inhibitors show promise in reducing severity of acute pancreatitis

The efficacy and safety of cyclooxygenase-2 (COX-2) inhibitors were evaluated in a prospective, multicentre trial, which demonstrated a significant reduction in the occurrence and duration of severe acute pancreatitis (SAP).

Dr Lu-Ming Huang (West China Hospital of Sichuan University, China) presented the findings of a study conducted across 10 hospitals in China aimed at evaluating the preventive and treatment effects of COX-2 inhibitors on SAP [1]. The study enrolled 348 patients with SAP, characterised by an APACHE II score of ≥7 or a modified Marshall score of ≥2, within 7 days of symptom onset. Participants were randomly assigned to either the COX-2 inhibitors group (receiving parecoxib 40 mg intravenously daily for the first 3 days, followed by imrecoxib 100 mg orally twice a day from day 4 to day 30) or the placebo group.

The occurrence of SAP in the COX-2 inhibitors group was significantly reduced compared with the placebo group (61.5% vs 77.6%; P<0.05). Additionally, the duration of organ failure was significantly shorter in the COX-2 inhibitors group, with a median of 6.9 days compared with 9.7 days in the placebo group (P<0.05). The duration of mechanical ventilation and respiratory failure was also shorter in the COX-2 inhibitors group than in the placebo group (6.0 vs 8.2 days; P=0.009 and 6.7 vs 9.2 days; P=0.001, respectively). The levels of pro-inflammatory cytokines were notably lower in the COX-2 inhibitors group, indicating an alleviation of the systemic inflammatory response.

Adverse events were reported in 14.9% of the placebo group and 17.8% of the COX-2 inhibitors group, showing a comparable safety profile.

Dr Huang summarised: “Through this multicentre trial, we can conclude that COX-2 inhibitors have inhibitory effects on multiple inflammatory mediators, suppress or reduce the progression of predicted SAP, shorten the organ failure duration, reduce local complications, and thus improve clinical outcomes with good safety.”

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   1. Huang L, et al. Prevention and treatment of severe acute pancreatitis with cyclooxygenase-2 inhibitors - an investigator-initiated, prospective, multi-center, double-blind, randomized, placebo-controlled clinical trial. 890, DDW 2024, 18–21 May, Washington DC, USA.

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Posted on 11 July 202411 July 2024