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Association between use of azathioprine and risk of acute pancreatitis in children with inflammatory bowel disease: a Swedish-Danish nationwide cohort study
Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden.
Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Medicine, Stanford University School of Medicine, Stanford CA, USA .ORCID iD: 0000-0001-8264-6785
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2019 (English)In: Lancet Child and Adolescent Health, E-ISSN 2352-4642, Vol. 3, no 3, p. 158-165Article in journal (Refereed) Published
Abstract [en]

Background: Studies have shown an association between use of azathioprine and increased risk of acute pancreatitis in adult inflammatory bowel disease. However, whether an association exists among paediatric patients is not known. We aimed to investigate whether use of azathioprine is associated with the risk of acute pancreatitis in children with inflammatory bowel disease.

Methods: We did a nationwide register-based cohort study in Sweden (2006-16) and Denmark (2000-16). All paediatric patients (<18 years of age) with inflammatory bowel disease during the study period were identified through hospital records. Episodes of incident azathioprine use and no use of any thiopurine were matched (1:1) using propensity scores, controlling for sociodemographic characteristics, comorbidities, previous treatment, indicators of disease severity, and health care use. Incident acute pancreatitis (physician-assigned diagnosis with ICD-10 code K85) occurring in the 90 days following treatment initiation were identified through outpatient and inpatient hospital records.

Findings: We identified 3574 azathioprine episodes and 18 700 no-use episodes, which resulted in 3374 pairs after propensity score matching; baseline characteristics in the matched cohort were well balanced. Among the matched azathioprine episodes, mean age was 14.3 years (SD 3.1), 1854 (54.9%) were male, 1923 (57.0%) had Crohn's disease, and 1451 (43.0%) had ulcerative colitis or unclassified inflammatory bowel disease. Within the first 90 days following initiation of azathioprine, 40 acute pancreatitis events occurred (incidence rate 49.1 events per 1000 person-years) compared with six events in the no-use group (8.4 events per 1000 person-years). Azathioprine use was associated with an increased risk of acute pancreatitis (incidence rate ratio 5.82 [95% CI 2.47-13.72]; absolute difference 1.0 [95% CI 0.3-2.6] events per 100 patients) during the 90-day risk period.

Interpretation: Use of azathioprine was associated with an increased risk of acute pancreatitis in children with inflammatory bowel disease during the first 90 days following treatment initiation, suggesting the need for regular and rigorous monitoring. The risk of acute pancreatitis needs to be considered when deciding on optimal treatment strategies.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 3, no 3, p. 158-165
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:oru:diva-72869DOI: 10.1016/S2352-4642(18)30401-2ISI: 000458662400016PubMedID: 30685366Scopus ID: 2-s2.0-85061370852OAI: oai:DiVA.org:oru-72869DiVA, id: diva2:1292893
Funder
Swedish Research Council, 2016-01974Åke Wiberg Foundation
Note

Funding Agencies:

Frimurare Barnhuset Foundation

Strategic Research Area Epidemiology programme at Karolinska Institutet

Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-01Bibliographically approved

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Ludvigsson, Jonas F.

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