Continuous regional arterial infusion versus intravenous administration of the protease inhibitor nafamostat mesilate for predicted severe acute pancreatitis: a multicenter, randomized, open-label, phase 2 trial
Year: 2019
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: Continuous regional arterial infusion (CRAI) of protease inhibitor nafamostat mesilate (NM) is used in the context of predicted severe acute pancreatitis (SAP) to prevent the development of pancreatic necrosis. Although this therapy is well known in Japan, its efficacy and safety remain unclear. METHODS: This investigator-initiated and -driven, multicenter, open-label, randomized, controlled trial (UMIN000020868) enrolled 39 patients with predicted SAP and low enhancement of the pancreatic parenchyma on computed tomography (CT). Twenty patients were assigned to the CRAI group, while 19 served as controls and were administered NM at the same dose intravenously (IV group). The primary endpoint was the development of pancreatic necrosis as determined by CT on Day 14, judged by blinded central review. RESULTS: There was no difference between the CRAI and IV groups regarding the percentages of participants who developed pancreatic necrosis (more than 1/3 of the pancreas: 25.0%, range 8.7-49.1% vs. 15.8%, range 3.4-39.6%, respectively, P = 0.694; more than 2/3 of the pancreas: 20%, range 5.7-43.7% vs. 5.3%, range 0.1-26.0%, respectively, P = 0.341). The early analgesic effect was evaluated based on 24-h cumulative fentanyl consumption and additional administration by intravenous patient-controlled analgesia. The results showed that the CRAI group used significantly less analgesic. There were two adverse events related to CRAI, namely bleeding and splenic infarction. CONCLUSIONS: CRAI with NM did not inhibit the development of pancreatic necrosis although early analgesic effect of CRAI was superior to that of IV. Less-invasive IV therapy can be considered a viable alternative to CRAI therapy.
Source: Journal of Gastroenterology
Authors: Morihisa Hirota, Tooru Shimosegawa, Katsuya Kitamura, Kazunori Takeda, Yoshifumi Takeyama, Toshihiko Mayumi, Tetsuhide Ito, Mamoru Takenaka, Eisuke Iwasaki, Hirotaka Sawano, Etsuji Ishida, Shin Miura, Atsushi Masamune, Yousuke Nakai, Akira Mitoro, Hiroyuki Maguchi, Kenji Kimura, Tsuyoshi Sanuki, Tetsuya Ito, Hiroki Haradome, Kazuto Kozaka, Toshifumi Gabata, Keisho Kataoka, Masahiko Hirota, Shuji Isaji, Ryoji Nakamura, Koki Yamagiwa, Chie Kayaba, Koji Ikeda
Institutions: Tohoku Medical and Pharmaceutical University Hospital, Kumamoto Medical Center, Kumamoto Regional Medical Center, Tohoku Medical and Pharmaceutical University, South Miyagi Medical Center, SHOWA Medical University, Tokyo Medical University Hachioji Medical Center, Kindai University, University of Occupational and Environmental Health Japan, Shinshu University Hospital, Nagano Red Cross Hospital, Fukuoka Sanno Hospital, International University of Health and Welfare, Keio University, Saiseikaisenri Hospital, Kurashiki Central Hospital, Tohoku University, The University of Tokyo, Nara Medical University, Teine Keijinkai Hospital, Sendai Medical Center, National Hospital Organization, Kita Harima Medical Center, Kitasato University, Kanazawa University, Otsu Municipal Hospital, Mie University, Tohoku University Hospital, Clinical Research, Innovation and Education Center, Tohoku University Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W2990815134