Effectiveness And Safety Of Protease Inhibitors In Treatment Of Acute Pancreatitis:A Meta Analysis

Background: Acute pancreatitis is one of common diseases with severe complications and significant mortality. Prior studies showed controversial results on the efficacy and safety of protease inhibitors(gabexate mesilate and Ulinastatin) in treatment.Objective: The aim of this study was to systematically review all randomized controlled trials with regard to important outcomes in patients with AP who received protease inhibitors.Method: Trials were identified by strict including and excluding criteria. A wide literature search was performed in Cochrane library,Pubmed,Embase,CBM,CNKI and Wanfang database. Eligible studies were randomized controlled trials that compared the effects of protease inhibitors administration with placebo treatment in patients with AP. Meta-analysis was conducted using Rev Man 5.2 offered by Cochrane collaboration.Result: Twenty seven clinical RCT studies involving 2599 patients were included. The results of meta-analysis showed:(1) In Gabexate group: there were significant difference in total efficiency(P<0.00001), the incidence of complications(P=0.04), the remission time of abdominal pain(P<0.00001), the time for blood amylase returning to normal(P<0.00001), the average length of hospital stay(P=0.03), but there were no significant difference in mortality(P=0.07) between gabexate group and control group, The reported severe adverse events of gabexate appeared to be rare.(2) In Ulinastatin group: there were significant difference in total efficiency(P<0.00001), mortality(P=0.003), the incidence of complications(P=0.0008), the remission time of abdominal pain(P<0.00001), the time for blood amylase returning to normal(P<0.00001), the average length of hospital stay(P<0.00001). The reported severe adverse events of ulinastatin appeared to be rare.Conclusion: Protease inhibitors(gabexate and ulinastatin) appears to be a modality of effective and safe treatment with a favorable trend,but there is not enough evidence to support this conclusion at present as trails published is not good quality. More multi-center and large-sample randomized controlled trails are needed to do further study.