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Drug Watch: Antioxidant Therapy for Recurrent Pancreatitis

There is little to offer patients with recurrent pancreatitis in way of treatment. These patients suffer considerable pain, and about the only measure that will guarantee long-term pain relief is near-total pancreatectomy - which carries the penalties of malabsorption and brittle diabetes. Though the number of patients with chronic pancreatitis will be small across the UK, there may be pockets of relatively high prevalence, largely in deprived areas. These patients will consume significant amounts of health service resources - even more if near-total pancreatectomy is carried out. Any therapy which can be shown to be effective in chronic pancreatitis will therefore have an impact on healthcare provision.

Causes of pancreatitis

There is accumulating evidence that oxidant stress resulting from an excess of pro-oxidant over antioxidant has a key role in acute oedematous pancreatitis as well as painful exacerbations of chronic disease. Cytokines like platelet activation factor (PAF) have also been shown to be involved with development of the acute disease in animal models, but it is likely that the prime insult which triggers pancreatitis is oxidant stress.

Antioxidant therapy?

From this, it would seem likely that therapy with antioxidants should help to prevent pancreatitis - especially recurrent pancreatitis. A randomised, controlled, double-blind, double dummy, crossover study from the Manchester Royal Infirmary has shown this to be the case. Twenty patients with chronic pancreatitis (8 idiopathic, 7 alcoholic and 5 idiopathic acute) entered the study in which micronutrient antioxidant therapy was compared with placebo, each for a 20-week period. Patients took six tablets of selenium Ace (Wassen International) and eight tablets of methionine (Evans Medical Ltd) in divided doses, giving a daily total of:

  • 600 µg organic selenium
  • 9000 IU beta-carotene
  • 0.54 g vitamin C
  • 270 IU vitamin E
  • 2 g methionine


Results

This was a thorough and detailed study. The bare-bones of the results were that while six patients had an attack while on placebo, not one had an attack while on active medication. Pain scores were significantly lower on active treatment than on placebo and at baseline. The blood concentrations of a free radical 'marker' - the percentage molar ratio of 9,11-linoleic acid to 9,12-linoleic acid - were elevated at baseline and in patients on placebo, but was normalised by active treatment.

Benefits and costs

Treatment would entail a maximum cost of about £15 a month (1990 prices), with possibly a 50% reduction after six months. This financial outlay is small compared with the cost in terms of the mortality, morbidity, narcotic use, malnutrition and brittle diabetes of near-total pancreatectomy.

Reference:

S Uden et al. Antioxidant therapy for recurrent pancreatitis: placebo controlled trial. Alimentary Pharmacology and Therapeutics 1990 4: 357-71.

Questions to be Answered

Q: What need is met by this therapy?
A: Treatment of patients with chronic or recurrent acute pancreatitis.
Q: What happens now?
A: Patients are treated with analgesics, or may go on to near-total pancreatectomy resulting in malabsorption and diabetes.
Q: Is quality improved?
A: Yes - patients on this treatment do not have pain.
Q: What does the treatment cost?
A: Less than £15 per month per patient.
Q: Can cost savings be made?
A: Yes - though not quantified, the cost of treatment with antioxidants is likely to be much less than present treatments.

Advice to Health Authorities and GPFHs

  • Will increase quality and effectiveness.
  • May result in reduced costs.
  • Worth considering in specification.



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