Pediatric IBD: azathioprine tied to increased acute pancreatitis risk

  • Lancet Child Adolesc Health

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In children with IBD, use of azathioprine is tied to increased acute pancreatitis risk in the first 90 days after starting treatment, with 1 extra case per 100 patients.
  • Results underscore need for close monitoring during this period.

Why this matters

  • Azathioprine has already been linked to acute pancreatitis risk in adults with IBD.

Key results

  • Among those with episodes, 57.0% had Crohn's, 43.0% had ulcerative colitis/unclassified disease.
  • In azathioprine vs no-azathioprine groups in first 90 days (matched cohort):
    • 49.1 vs 8.4 acute events per 1000 person-years.
    • Incidence rate ratio: 5.82 (95% CI, 2.47-13.72).
    • Absolute difference: 1.0 (95% CI, 0.3-2.6) events per 100 patients.
  • Hospitalization rates for acute pancreatitis were similar between groups (90% with drug vs 83% without).
  • Azathioprine group had shorter inpatient stay (5.1 [interquartile range, 3.2-9.0] vs 18.4 [14.3-24.7] days).

Study design

  • National registry cohorts, Sweden and Denmark; 8725 children with IBD propensity matched between use and no use of azathioprine.
  • Funding: Swedish Research Council, Frimurare Barnhuset Foundation, Åke Wiberg Foundation.

Limitations

  • Possible that dispensed drugs were not fully consumed.
  • Small event rates in no-use group.
  • As with all register-based studies, we assumed that dispensed drugs were consumed. 

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