Celecoxib use linked to higher pancreatitis risk

Last Updated: 2015-09-18

By David Douglas

NEW YORK (Reuters Health) - Use of celecoxib is associated with an increased risk of acute pancreatitis, according to Taiwanese researchers.

Based on the findings, "we should remind physicians to add acute pancreatitis to their differential diagnosis list when working on patients who are currently taking celecoxib and having acute abdominal pain," Dr. Shih-Chang Hung of Nantou Hospital told Reuters Health by email.

Celecoxib has become the main selective COX-2 inhibitor used in Taiwan, Dr. Hung and colleagues note in The American Journal of Gastroenterology, online September 1. However, gastrointestinal and cardiovascular risks are still debated.

To investigate the association with acute pancreatitis, suggested by earlier reports, the team examined data from 2000 to 2011 on more than 5,000 patients with a first admission episode of acute pancreatitis. More than 20,000 randomly selected, matched subjects without the disease acted as controls.

Compared with never-users, patients who had received at least one prescription for celecoxib within three days before diagnosis had a significantly higher risk of acute pancreatitis (adjusted odds ratio, 5.62).

In patients who used an average daily dose of more than 200 mg of celecoxib the odds ratio was 14.4. In those who used less, it was 4.38.

Patients with acute pancreatitis also had higher rates of using other COX-2 inhibitors (30% vs. 24%) and of comorbidities, including alcohol-related disease (12% versus 1%) and cholelithiasis (23% vs. 3%).

The researchers conclude that current use of celecoxib, even at lower doses "might increase the risk of acute pancreatitis significantly." This risk, they add, "was slightly higher for patients who used more than 200 mg of celecoxib per day."

Commenting on the findings by email, Dr. Alvaro Alonso, an epidemiologist at the University of Minnesota in Minneapolis, told Reuters Health that the "study reports, using a solid study design and a large sample size, another drug associated with acute pancreatitis. The results provide a better understanding of the risk profile of celecoxib, a popular anti-inflammatory drug."

"However," he concluded, "given the low risk of acute pancreatitis in the general population, the study should not lead necessarily to patients interrupting the use of celecoxib."

SOURCE: http://bit.ly/1W7d02V

Am J Gastroenterol 2015.