PhD Scientific Days 2022

Pharmaceutical Sciences II. (Poster discussion will take place in the Aula during the Coffee Break)

Combination of ulinastatin and somatostatin reduces complication rates in acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Text of the abstract

Introduction
Currently, there is no specific pharmaceutical agent for treating acute pancreatitis (AP). Somatostatin and its analogues have been used to prevent the autolysis of the pancreas in AP; however, their effectiveness has not been confirmed.
Aim
This investigation aimed to examine the safety and efficacy of ulinastatin, a protease inhibitor combined with somatostatin analogues in the treatment of AP.
Materials and methods
We conducted a systematic database search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to identify randomized controlled trials in which the efficacy of ulinastatin in combination with somatostatin analogue was compared to somatostatin analogue alone in patients with AP. The meta-analysis is reported according to PRISMA guidelines. For statistical analysis the random effect model were used; odds ratio (OR) and mean differences (MD) with confidence interval (CI) were calculated. I2 value and Χ2 test evaluated statistical heterogeneity.
Results
In total of 60 articles, comprising 1037 patients were included in the meta-analysis. Disease severity and posology for treatment in each group varied across the studies. The combination therapy significantly increased the symptom reduction rate [OR 3.51; 95%CI 2.30-5.37; I2=0%], and decreased length of hospital stay [9.43 days; 95%CI (-12.55)-(-6.31); I2=97%]. Furthermore, it reduced the complications rate for acute respiratory distress syndrome [OR 0.27; 95%CI 0.13-0.60; I2=28%]; acute kidney injury [OR 0.29; 95%CI 0.09.-0.97; I2=49%] and multiple organ dysfunction syndrome [OR 0.39; 95%CI 0.20-0.75; I2=0]. The decrease in mortality was not statistically significant [OR 0.55; 95%CI 0.29-1.07; I2=0%].
Conclusions
The combination therapy decreased complication rates (of MODS, ARDS, AKI). Symptoms were relieved threefold with the combination therapy compared to somatostatin alone and resulted in a significantly shortened length of hospital stay. Further RCTs of greater sample sizes would better evaluate the effect on major complications rates and mortality of this combination therapy.