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Amiodarone associated with acute pancreatitis in patients with AF
Acute pancreatitis could be an adverse effect of amiodarone use in patients with atrial fibrillation, according to results of a nested case-control study.
An association between amiodarone and acute pancreatitis in this population has been previously observed in isolated reports, but not in large studies, researchers wrote in a research letter published in JAMA Internal Medicine.
Using Truven Health databases of insurance claims, researchers analyzed 1,686 patients with nonvalvular AF hospitalized with acute pancreatitis from 2007 to 2012 and 8,430 matched controls with nonvalvular AF but no acute pancreatitis (mean age, 71 years; 39.3% women).
Five controls were matched with each case based on sex, year of birth and insurance plan enrollment date. The researchers obtained information on use of amiodarone, other medications and comorbidities for all participants.
Patients with pancreatitis were more likely to be using amiodarone (cases, 14.5%; controls, 9%; OR = 1.53; 95% CI, 1.24-1.88) compared with patients without pancreatitis. The researchers reported no association between acute pancreatitis and use of other antiarrhythmic drugs, including dronedarone (Multaq, Sanofi Aventis), sotalol, flecainide, propafenone and dofetilide (Tikosyn, Pfizer).
The odds of a link between amiodarone and pancreatitis were greater when amiodarone therapy was initiated within 12 months of the event date (OR for within 12 months = 1.86; 95% CI, 1.41-2.45; OR for after 12 months = 1.21; 95% CI, 0.89-1.64; P for difference = .04) compared with never-users. The researchers did not find that cumulative use increased the odds of acute pancreatitis (P for trend = .49).
Since the incidence rate of acute pancreatitis is estimated at three to four cases per 10,000 adults per year, the association would result in an additional one to two cases of acute pancreatitis per 10,000 adults per year, the researchers wrote.
“The mechanisms responsible for this association are unknown, although direct cytotoxicity or immune-mediated pathways, as described for amiodarone-related pulmonary toxic effects, could be potential explanations,” Alvaro Alonso, MD, PhD, from the division of epidemiology and community health at the school of public health at the University of Minnesota, Minneapolis,
and colleagues wrote. “Even though the absolute risk of acute pancreatitis in the general population is low, health care professionals should be aware of this potential association in the treatment of patients with [nonvalvular] AF or acute pancreatitis.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.