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Original Investigation
Mar 25, 2013

Association of Oral Glucocorticoid Use With an Increased Risk of Acute Pancreatitis: A Population-Based Nested Case-Control Study

Author Affiliations

Author Affiliations: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Drs Sadr-Azodi, Bexlius, Lindblad, Lagergren, and Ljung and Mr Mattsson); and Division of Cancer Studies, King's College London, London, England (Dr Lagergren).

JAMA Intern Med. 2013;173(6):444-449. doi:10.1001/jamainternmed.2013.2737

Importance Oral glucocorticoid use has been suggested to cause acute pancreatitis in several case reports. However, no epidemiological study has investigated this association.

Objective To conduct a nationwide population-based case-control study to investigate the potential association between oral glucocorticoid use and acute pancreatitis.

Design In this population-based case-control study, all individuals aged 40 to 84 years who developed a first episode of acute pancreatitis between 2006 and 2008 in Sweden were identified.

Setting Population-based, nationwide, register-based study.

Participants A total of 6161 cases with a first episode of acute pancreatitis and 61 637 controls were included in the final analyses. Cases were all patients diagnosed as having a first episode of acute pancreatitis during the study period, defined by the diagnosis code K85 in the International Statistical Classification of Diseases, 10th Revision (ICD-10). Controls were randomly selected from the source population at risk of developing acute pancreatitis. For each case, 10 controls, matched for age, sex, and calendar period, were randomly selected from the general population. Oral glucocorticoid use was assessed from the Swedish Prescribed Drug Register. Current, recent, and former users were defined as patients who collected their glucocorticoid prescription within 30, 31 to 180, and after 180 days before the index date, respectively

Main Outcome Measures Unconditional logistic regression was performed to calculate the odds ratios (ORs) with 95% confidence intervals for the association between oral glucocorticoid use and acute pancreatitis. Multivariable adjustment was made for potential confounders including, among others, alcohol abuse, diabetes, and concomitant drug use.

Results The study included 6161 cases of acute pancreatitis and 61 637 controls. The risk of acute pancreatitis was increased among current users of oral glucocorticoids compared with nonusers (OR, 1.53; 95% CI, 1.27-1.84). This risk was highest 4 to 14 days after drug dispensation (OR, 1.73; 95% CI, 1.31-2.28) and attenuated thereafter. There was no association between oral glucocorticoid use and acute pancreatitis immediately after drug dispensation. There was no increased risk of acute pancreatitis among recent or former users of glucocorticoids compared with nonusers.

Conclusions and Relevance Current oral glucocorticoid use is associated with an increased risk of acute pancreatitis.