Evolocumab in treatment of acute pancreatitis induced by hypertriglyceridemia
Abstract
Acute pancreatitis (AP) is a common emergency resulting from inflammation of the pancreas. The mechanism involves premature activation of enzyme precursors in the acinar cells triggering a self-digestive inflammatory cascade. Hypertriglyceridemia is the most common etiology of pancreatitis after gall stones and alcohol. It usually follows a sudden surge such as diabetic ketoacidosis on top of hereditary hyperlipidemia. In the present case report; we describe a patient with type-I diabetes mellitus who had developed recurrent attacks of hypertriglyceridemia AP (HTG-AP) despite Fenfibrate-therapy and report on our experience with Evolocumab in his treatment and prophylaxis.
Keywords: diabetes mellitus, hypertriglyceridemia, pancreatitis, prophylaxis, treatment.
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References
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2- Dominguez-Munoz JE, Malfertheiner P, Ditschuneit HH, Blanco-Chavez J, Uhl W, Buchler M, et al. Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset and severity of the disease. Int J Pancreatol 1991; 10:261–267.
3- Whitcomb DC, Yadav D, Adam S, et al. North American Pancreatic Study Group. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology 2008; 8:520–531.
4- Seales CE, Ooi TC. Underrecognition of chylomicronemia as a cause of acute pancreatitis. CMAJ 1992; 147:1806–1808.
5- Fredrickson, DS; Lees, RS (1965). A system for phenotyping hyperlipoproteinemia. Circulation 1965; 31:321–327
6- Lithell H, Vessby B, Walldius G, Carlson LA. Hypertriglyceridemia-acute pancreatitis-ischemic heart disease. A case study in a pair of monozygotic twins. Acta Med Scand 1987; 221:311–316.
7- Kimura W, Mossner J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancretitis in rats. Int J Pancreatol 1996; 20:177–184
8- Smotkin J, Tenner S. Laboratory diagnostic tests in acute pancreatitis. J Clin Gastroenterol 2002; 34:459–462.
9- Joshua A, Greenberg JA, Hsu J. Bawazeer M, Marshall J, Friedrich JO, Cobrun N, May GR, Pearsall E, McLead RS. Clinical practice guideline: management of acute pancreatitis. Can J Surg 2016; 59:128–140.
10- Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, et al. Diabetes, plasma insulin and cardiovascular disease: Subgroup analysis from the Department of Veterans Affairs high density lipoprotein intervention trial (VA-HIT) Arch Intern Med 2002; 162: 2597–2604.
11- Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, et al. Helsinki Heart Study: Primary-prevention trial with gemfibrozil in middle aged men with dyslipidemia. Safety of treatment, changes in risk factors and incidence of coronary heart disease. N Engl J Med 1987; 317:1237–1245.
12- Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apheresis 2003; 18:181–185
13- Weinreich, M; Frishman, W. "Antihyperlipidemic therapies targeting PCSK9". Cardiology in Review 2014; 22:140–6.
14- FDA News Release (August 27, 2015). FDA approves Repatha to treat certain patients with high cholesterol. U.S. Food and Drug Administration. Retrieved 30 August 2015.
15- Sabatine MS, Giugliano RP, Keech, AC, Honarpour N, Wiviott SD, Murphy SA, Kuder JF, Wang H, Liu T. "Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N England J Med 2017; 376:1713–1722.
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El-Reshaid K, Al-Bader S, Markova Z. Evolocumab in treatment of acute pancreatitis induced by hypertriglyceridemia. JDDT [Internet]. 15Nov.2019 [cited 31May2020];9(6):136-9. Available from: http://jddtonline.info/index.php/jddt/article/view/3717
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