Dataset Information

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.

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.

SUBMITTER: Hirota M

PROVIDER: S-EPMC7026212 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

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.

Hirota Morihisa M Shimosegawa Tooru T Kitamura Katsuya K Takeda Kazunori K Takeyama Yoshifumi Y Mayumi Toshihiko T Ito Tetsuhide T Takenaka Mamoru M Iwasaki Eisuke E Sawano Hirotaka H Ishida Etsuji E Miura Shin S Masamune Atsushi A Nakai Yousuke Y Mitoro Akira A Maguchi Hiroyuki H Kimura Kenji K Sanuki Tsuyoshi T Ito Tetsuya T Haradome Hiroki H Kozaka Kazuto K Gabata Toshifumi T Kataoka Keisho K Hirota Masahiko M Isaji Shuji S Nakamura Ryoji R Yamagiwa Koki K Kayaba Chie C Ikeda Koji K

Journal of gastroenterology 20191122 3

<h4>Background</h4>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.<h4>Methods</h4>This investigator-initiated and -driven, multicenter, open-label, randomized, controlled trial (UMIN000020868) enrolled 39 patients with predicted SAP and low enhancemen ...[more]

PMID: 31758329

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Dataset Information

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.

Background

Methods

Results

Conclusions

Publications

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.

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