Pharmacological Interventions for Acute Pancreatitis in Adults: An Overview of Systematic Reviews

AIM: To provide a comprehensive assessment of the efficacy and safety of pharmacological interventions for AP. METHODS: This was an overview of systematic reviews based on randomized controlled trials comparing pharmacological interventions with placebo or blank control in adults with AP. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to January 13, 2024, with an update on February 4, 2025. The effect value of each medication on each outcome of interest defined as a "combo" was assessed. Findings were categorized as efficacious, not efficacious, or inconclusive. RESULTS: Fifteen reviews (167 unique trials, 12,930 participants) reported the efficacy of 14 medications on 5 outcomes, yielding 35 distinct combos. Seven combos showed efficacy with low certainty evidence: low molecular weight heparin (risk ratio 0.31, 95% confidence interval, 0.18-0.51), omega-3 fatty acids (0.30, 0.14-0.65), and antioxidants (0.69, 0.49-0.98) for mortality; low molecular weight heparin (0.38, 0.22-0.65), chengqi-series decoctions (0.48, 0.36-0.63), and ulinastatin (0.43, 0.24-0.78) for multiple organ failure; and neostigmine (mean difference -2.81, 95 % confidence interval -3.75 to -1.87) for length of intensive care unit stay. Half of the remaining combos showed no efficacy, while the other half was inconclusive for very low certainty evidence. Safety data were limited, with one review reporting no significant adverse events for neostigmine. CONCLUSIONS: Some pharmacological interventions exhibited potential efficacy for specific AP outcomes, albeit with low certainty evidence. Further verifying those medications is crucial in advancing the treatment landscape for AP.