Ulinastatin and somatostatin combo lowers risk of complications in acute pancreatitis

HUNGARY: According to a research study published in the journal Scientific Reports, ulinastatin in combination with a somatostatin analogue substantially reduced the rate of complications in acute pancreatitis when compared to somatostatin analogue monotherapy.

The abrupt inflammation of the pancreas is known as acute pancreatitis (AP). Better patient outcomes require the early detection and management of AP. There isn't a single pharmaceutical agent available currently to treat acute pancreatitis (AP). The efficacy of somatostatin and its equivalents in preventing the autolysis of the pancreas in AP has not been established. Several clinical trials involving the combination of ulinastatin and somatostatin or its counterpart octreotide produced encouraging findings, but the strength of the evidence is still weak.

This study compared the effectiveness and safety of somatostatin derivatives alone to ulinastatin combined with somatostatin or octreotide in the treatment of acute pancreatitis.

In order to find randomized controlled trials where the effectiveness of ulinastatin combined with somatostatin analogue was compared to somatostatin analogue alone in patients with AP, the authors did a systematic database search in 4 databases. Because the patient populations of the examined studies' patient populations varied slightly, they employed random effect models to calculate odds ratios (OR), mean differences (MD), and the accompanying 95% confidence intervals (CI). The meta-analysis included a total of 9 studies with a combined 1037 patients. The main outcomes were mortality, complications, including Acute Respiratory Distress Syndrome (ARDS), shock, Acute Kidney Injury (AKI), Multiple Organ Dysfunction Syndrome (MODS), and hospital stay duration.They assessed adverse events, changes in laboratory markers, and the rate of symptom reduction as secondary outcomes.

Key highlights of the study:

• The incidences of ARDS and AKI were reduced by around 70% with the combination therapy [OR 0.27; 95% CI 0.13-0.60; I2 = 28%] and [OR 0.29; 95% CI 0.09.-0.97; I2 = 49%], respectively, whereas MODS could be avoided in about 60% of cases [OR 0.39; 95% CI 0.20-0.75; I2 = 0%].
• The reduction in shock incidence [OR 0.46; 95% CI 0.20-1.07; I2 = 39%] was not statistically significant.
• reduced death rate was shown with the combined therapy [OR 0.55; 95% CI 0.29-1.07; I2 = 0%]; nevertheless, the outcome was not statistically significant.
• In comparison to the control group, the intervention group's admission time was cut by 9.43 days (95% CI (-12.55)-(-6.31); I2 = 97%).
• When compared to somatostatin alone, combined therapy dramatically provided a threefold reduction in symptom relief.

"It is a clinically beneficial therapy with fewer days spent in the hospital and lower complication rates. Both short-term and long-term savings could be made on additional health care costs "the researchers wrote.

In the treatment of AP, somatostatin analogue monotherapy is insufficiently successful. It should be further researched, they added, even though the results provided here indicate an improvement in efficacy when paired with ulinastatin.

The authors came to the conclusion that this meta-analysis offers fresh information regarding a potential pharmacological therapy treatment for acute pancreatitis. Given the limited number of available treatments and the high death rate, this is particularly crucial in severe situations.

REFERENCE

Horváth, I.L., Bunduc, S., Fehérvári, P. et al. The combination of ulinastatin and somatostatin reduces complication rates in acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 12, 17979 (2022). https://doi.org/10.1038/s41598-022-22341-7