Etodolac and the risk of acute pancreatitis

Objective: The aim of this study was to explore the association between etodolac use and acute pancreatitis in Taiwan.Design: We designed a case-control study using the database of Taiwan's National Health Insurance.Subjects: In all, 7577 subjects aged 20 years or older with newly diagnosed acute pancreatitis were defined as cases, and 27032 sex-matched and age-matched subjects without acute pancreatitis were defined as controls.The period considered for this study was from 1998 to 2011.For the study, never having used etodolac is defined as a subject never receiving a prescription for etodolac.Active use of etodolac is defined as a subject receiving at least 1 prescription for etodolac within 7 days of the date of their being diagnosed with acute pancreatitis.Non-active use of etodolac is defined as a subject not receiving a prescription for etodolac within 7 days but receiving at least 1 prescription for etodolac ≥ 8 days before the date of their being diagnosed with acute pancreatitis.Main outcome measure: The association between etodolac use and acute pancreatitis was estimated by using the multivariable unconditional logistic regression model.Results: After correcting for covariates, the adjusted odds ratio of acute pancreatitis was 3.78 for subjects with active use of etodolac (95% confidence interval 1.11, 12.9), compared with subjects who never used etodolac.The adjusted odds ratio decreased to 1.18 for subjects with non-active use of etodolac (95% confidence interval 0.38, 3.67), but that was without statistical significance.Conclusion: There could be an association between active use of etodolac and acute pancreatitis.Clinicians should take into account the possibility of etodolac-associated acute pancreatitis when patients currently using etodolac present with acute pancreatitis with an unknown cause.(FDA) has reported that among the 4290 persons taking etodolac who experienced side effects from 2003 to 2012, 27 persons (0.63%) had pancreatitis [7].Although there is no formal pharmacoepidemiological study available to focus on the association between etodolac use and acute pancreatitis, based on the aforementioned U.S. FDA report, we think there might be an association between etodolac use and acute pancreatitis.If the association really exists, physicians should alert etodolac users to the risk of acute pancreatitis.It is with this in mind that we conducted this case-control study by analyzing the database of Taiwan's National Health Insurance Program to explore this issue of etodolac use and acute pancreatitis.