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Statins but not fibrates associated with lower risk of pancreatitis

Clinical Question:
Do lipid-modifying therapies decrease the risk of pancreatitis?

Bottom Line:
This systematic review found that statin therapy is significantly associated with a reduced risk of pancreatitis. Fibrate therapy, however, was not significantly associated with a lower risk of pancreatitis. In fact, a secondary analysis of only published data found a significantly increased risk of pancreatitis associated with fibrate therapy. Because most of the trials excluded participants with marked hypertriglyceridemia, the authors note that clinical trials comparing fibrate therapy and statin therapy in these patients are necessary to guide future clinical practice. In the meantime, if someone in my family needed treatment, I would choose statin therapy over fibrate therapy. (LOE = 1a)

Preiss D, Tikkanen MJ, Welsh P, et al. Lipid-modifying therapies and risk of pancreatitis. A meta-analysis. JAMA 2012;308(8):804-811.  [PMID:22910758]

Study Design:
Meta-analysis (randomized controlled trials)


Various (meta-analysis)

Although fibrate therapy is recommended to reduce pancreatitis risk in patients with hypertriglyceridemia, it may increase the risk of gallstones and thus subsequent pancreatitis. These investigators searched multiple databases including MEDLINE, EMBASE, Web of Science, and reference lists from relevant publications without language restrictions for randomized controlled trials of both statin therapy and fibrate therapy reporting incident pancreatitis. In order to identify unpublished trials they also searched the Food and Drug Administration database. Two reviewers independently assessed individual trials for inclusion criteria and methodologic quality using standard scoring criteria. Disagreements were resolved by consensus discussion with a third reviewer. Trials were of high quality with a median quality score of 5 (on a scale of 1-5, where higher scores indicate increased methodologic quality). Most trials excluded participants with marked hypertriglyceridemia. In 21 trials of statin therapy (N = 154,414), 309 patients developed pancreatitis: 134 using statin therapy and 175 using control therapy (risk ratio [RR] = 0.77; 95% CI, 0.62-0.97; number needed to treat = 1175; 693-9195 over 5 years). In 7 trials of fibrate therapy (N = 40,162), 144 patients developed pancreatitis: 84 using statin therapy and 60 using control therapy (RR = 1.39; 1.00-1.95). Although analysis of all fibrate trials did not find a significant association with an increased risk of pancreatitis, a sensitivity analysis of only trials with published data did find a significantly increased risk of pancreatitis with fibrate treatment (RR = 1.75; 1.07-2.86). There was no significant evidence of heterogeneity or publication bias.


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