Min Yu1, Zhen Yang1, Yin Zhu1, Nonghua Lu1. 1. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, PR China.
Abstract
BACKGROUND: The use of corticosteroid in the management of severe acute pancreatitis (SAP) remains contentious and is still being debated despite many pre-clinical studies demonstrating benefits. The limitations of clinical research on corticosteroid in SAP are disparities with regard to benefit, a lack of adequate safety data and insufficient understanding of its mechanisms of action. Thus, we performed a meta-analysis to assess the effectiveness of corticosteroid in experimental SAP and take a closer look at the relation between the animal studies and prospective trials. METHODS: Studies investigating corticosteroid use in rodent animal models of SAP were identified by searching multiple three electronic databases through October 2013, and by reviewing references lists of obtained articles. Data on mortality, changes of ascitic fluid and histopathology of pancreas were extracted. A random-effects model was used to compute the pooled efficacy. Publication bias and sensitivity analysis were also performed. RESULTS: We identified 15 published papers which met our inclusion criteria. Corticosteroid prolonged survival by a factor of 0.35 (95% CI 0.21-0.59). Prophylactic use of corticosteroid showed efficacy with regards to ascitic fluid and histopathology of pancreas, whereas therapeutic use did not. Efficacy was higher in large dose and dexamethasone groups. Study characteristics, namely type of steroids, rout of delivery, genders and strains of animal, accounted for a significant proportion of between-study heterogeneity. No significant publication bias was observed. CONCLUSIONS: On the whole, corticosteroids have showed beneficial effects in rodent animal models of SAP. Prophylactic use of corticosteroid has failed to validate usefulness in prophylaxis of postendoscopic retrogradcholangiopancreatography pancreatitis. Further appropriate and informative animal experiments should be performed before conducting clinical trials investigating therapeutic use in SAP.
BACKGROUND: The use of corticosteroid in the management of severe acute pancreatitis (SAP) remains contentious and is still being debated despite many pre-clinical studies demonstrating benefits. The limitations of clinical research on corticosteroid in SAP are disparities with regard to benefit, a lack of adequate safety data and insufficient understanding of its mechanisms of action. Thus, we performed a meta-analysis to assess the effectiveness of corticosteroid in experimental SAP and take a closer look at the relation between the animal studies and prospective trials. METHODS: Studies investigating corticosteroid use in rodent animal models of SAP were identified by searching multiple three electronic databases through October 2013, and by reviewing references lists of obtained articles. Data on mortality, changes of ascitic fluid and histopathology of pancreas were extracted. A random-effects model was used to compute the pooled efficacy. Publication bias and sensitivity analysis were also performed. RESULTS: We identified 15 published papers which met our inclusion criteria. Corticosteroid prolonged survival by a factor of 0.35 (95% CI 0.21-0.59). Prophylactic use of corticosteroid showed efficacy with regards to ascitic fluid and histopathology of pancreas, whereas therapeutic use did not. Efficacy was higher in large dose and dexamethasone groups. Study characteristics, namely type of steroids, rout of delivery, genders and strains of animal, accounted for a significant proportion of between-study heterogeneity. No significant publication bias was observed. CONCLUSIONS: On the whole, corticosteroids have showed beneficial effects in rodent animal models of SAP. Prophylactic use of corticosteroid has failed to validate usefulness in prophylaxis of postendoscopic retrogradcholangiopancreatography pancreatitis. Further appropriate and informative animal experiments should be performed before conducting clinical trials investigating therapeutic use in SAP.
Authors: Jose Gulfo; Angelo Ledda; Sabrina Gea-Sorlí; Laia Bonjoch; Daniel Closa; Mar Grasa; Montserrat Esteve Journal: PLoS One Date: 2016-01-07 Impact factor: 3.240