Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease Results From a Tertiary Referral Center


EŞKAZAN T., Bozcan S., Atay K., Yildirim S., Demir N., Celik S., ...More

PANCREAS, vol.50, no.9, pp.1274-1280, 2021 (Journal Indexed in SCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 50 Issue: 9
  • Publication Date: 2021
  • Doi Number: 10.1097/mpa.0000000000001914
  • Title of Journal : PANCREAS
  • Page Numbers: pp.1274-1280
  • Keywords: azathioprine, acute pancreatitis, azathioprine-induced gastrointestinal intolerance, inflammatory bowel disease, ADVERSE EVENTS, CROHNS-DISEASE, SMOKING, ASSOCIATION, RISK, CLASSIFICATION, AUTOANTIBODIES, SUSCEPTIBILITY, VARIANTS, MUTATION

Abstract

Objective The aim of the study was to identify the frequency of azathioprine-induced acute pancreatitis (AZA-AP) and related factors. Methods Seven hundred eighty-seven inflammatory bowel disease (IBD) patients on AZA therapy were retrospectively analyzed. Azathioprine-induced AP was diagnosed with positive imaging and/or an at least 3-fold increased amylase level, in presence of typical abdominal pain. The AZA-AP group was compared with patients on AZA therapy with no history of pancreatitis and 4 numerical adjacent cases with the same diagnosis were selected (group B). Results Fifty-four patients developed gastrointestinal symptoms (6.9%); however, only half of them (26 of 54) had pancreatitis, except 1, all within the first 2 months under AZA. When the AZA-AP group was compared with group B, only budesonide usage and active smoking were significantly more common in group A (46.2% vs 25%, P = 0.034, and 77% vs 51%, P = 0.017, respectively). Active smoking was the only independent risk factor for AZA-AP development (odds ratio, 3.208 [95% confidence interval, 1.192-8.632]). Conclusions All IBD patients developed AZA-AP nearly all within the first 2 months. Azathioprine intolerance may be a hidden diagnosis in at least half of the patients with AZA-AP symptoms. All smoker IBD patients should be monitored closely for AZA-AP development.