Lexipafant for acute pancreatitis: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIU Ning ¹ , YING Mingying ² , LI Jing ³

1. Gulou Hospital of Nanjing; 210008; Nanjing; China 2. ICU of West China Hospital of Sichuan University3. Departement of clinical epidemiology; West China hospital of Sichuan University; Chengdu 610041; China;

Corresponding author：

LIU Ning, Email: aliuning@sohu.com

Keywords：

Lexipafant; acute pancreatitis; randomized controlled trial; systematic review

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Background 　Acute pancreatitis is one of the most severe acute abdominal conditions. Recently with the understanding of pathophysiology and pathogenesis of acute pancreatitis, cytokines, especially platelet-activating factor (PAF), have been shown to play an important role. Lexipafant is a potent inhibitor of PAF. It has shown exiting results in the animal experiments, so randomized controlled studies are needed to assess the impact of lexipafant for acute pancreatitis.
Objectives 　To determine whether lexipafant can alter the course, prevent or treat organ failure and reduce mortality in acute pancreatitis.
Search strategy 　Electronic databases were searched and reference lists from included studies were also handsearched. Published abstracts from conference proceedings and ten kinds of Chinese medical journals were handsearched for additional citations. Personal contaction with colleagues and experts in the field of pancreatitis was performed to identify potentially relevant trials.
Selection criteria 　Randomized, controlled trials, In which participants went in hospital within 72 hours of belliache episode, comparing lexipafant to placebo or other interventions on organ failure rate or mortality of acute pancreatitis.
Data collection and analysis 　Data related to the clinical outcomes were extracted by two reviewers independently, if there was any divarication, they would have a discussion.
Main Results 　Three studies meet the inclusion criteria up to 2001. Compared with control group, lexipafant had the tendency of reducing the early deaths (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.23 to1.38, P=0.2), accelerating the recovery of organ failure (OR 0.40, 95%CI 0.12 to 1.32, P=0.13) and reducing the occurrence of new organ failure OR 0.34, but these results had no statistical significance. A large-scale multicentre randomized controlled trial including 1 500 patients has been completed in America, but the result has not been published.
Reviewers’ Conclusions 　Current evidence couldn’t draw the final conclusion. So the large-scale of randomized controlled trials is required.

Citation： LIU Ning,YING Mingying,LI Jing. Lexipafant for acute pancreatitis: a systematic review. Chinese Journal of Evidence-Based Medicine, 2003, 03(2): 108-113. doi: Copy

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1. ［1］Formark CE, Toskes PP. Acute pancreatitis- medical management[J]. Crit Care Clin 1995; 11:295 - 309.
2. ［2］Brady I, Christmas S, Sulton R, et al. Cytokines and acute paucreatitis 1Baillieres Best Pract Res [ J ] Clin Gastroenterol 1999;Jul, 13(2) :265 -89.
3. ［3］Norman J. The role of cytokines in the pathogenesis of acute pancreatitis[J]. AmJ Surg 1998; 175(1): 76-83.
4. ［4］Edward L, et al. A clinically based classification system for acutepancreatitis[J ]. Arch Surg 1993; 128(5) :586 - 90.
5. ［5］Vickers A, Goyal N, Harland R, et al. Do certain countries produce only positive results? A systematic review of controlled t rials [J]. Control Clin Trials 1998; 19:159-66.
6. ［6］kingsnorth AN, Gallowau SW, Formela LJ. Randomized, double-blind phase Ⅱ trial of lexipafant, a platelet -activating factor antagonist, in human acute pancreatitis[J ]. Br J Surg 1995; 82: 1414 - 20.
7. ［7］Mckay CJ, Curran F, Sharples C, et al. Prospective placebo controlled randomized trial of lexipafant in predicted severe acute pancreatits[J]. Br J Surg 1997; 84: 1239- 43.
8. ［8］Johnson CD, kingsnorth AN, Imrie CW, et al. Double blind, randomised, placebo controlled study of a platelet activating fator antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis[J]. Gut 2001; 48;62-9.
9. ［9］Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.0 [ updated July 1999 ]; Section 6. In: The Cochrane Library [database on CDROM]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issue 1.
10. ［10］British Biotech files 1st drug approval[J]. Scrip 1997; 2214:17.

Chinese Journal of Evidence-Based Medicine

Lexipafant for acute pancreatitis: a systematic review

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