Systematic Review and Meta-analysis of the Clinical Efficacy of Octreotide in Combination with Ulinastatin in the Treatment of Acute Pancreatitis.

Background and objectives: Acute pancreatitis (AP) is a serious disease characterized by local inflammatory responses in the pancreas. The annual incidence rate of acute pancreatitis is 4.9-73.4 per 100,000 people. Among these, approximately 20% develop into moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP), with a mortality rate of 13-35%. The aim of this study is to evaluate the efficacy and safety of octreotide in combination with ulinastatin in the treatment of acute pancreatitis using meta-analysis.

Methods: Chinese and English databases, including China National Knowledge Infrastructure Database (CNKI), WanFang database (WANFANG), Chinese Scientific Journals Full-text Database (VIP database), PubMed, Medline, and Web of Science, were searched for randomized controlled trials (RCTs) about octreotide in combination with ulinastatin in the treatment of acute pancreatitis from January 2019 to April 2024. Retrieved literature was screened independently by two researchers, and the methodological quality of included publications was evaluated according to bias risk assessment tool recommended by Cochrane 5.1. Data were statistically analyzed by using RevMan5.3 software.

Results: A total of 3026 patients from 30 studies in accordance with the criteria were included, including experimental group (n = 1516) and control group (n = 1510). Meta-analysis results showed that octreotide combined with ulinastatin could increase the effective rate of treatment for acute pancreatitis (relative risk (RR) = 1.23, 95% CI 1.19-1.27, P < 0.00001). The time in the experimental group for hospitalization (standardized mean difference (SMD) = -2.00, 95% CI [-2.67, -1.34], P < 0.00001), disappearance of abdominal pain (SMD = -1.75, 95% CI [-2.21, -1.29], P < 0.00001), disappearance of nausea and vomiting (SMD = -2.03, 95% CI [-2.93, -1.13], P < 0.00001), disappearance of abdominal distension (SMD = -2.02, 95% CI [-2.59, -1.44], P < 0.00001), and disappearance of peritoneal irritation (SMD = -2.20, 95%CI [-3.95, -0.46], P < 0.00001) was shorter than in the control group. The levels in the experimental group of TNFα (SMD = -2.01, 95% CI [-2.71, -1.32], P < 0.00001), CRP (SMD = -2.50, 95% CI [-3.20, -1.79], P < 0.00001), IL-6 (SMD = -2.67, 95% CI [-3.48, -1.85], P < 0.00001), IL-8 (SMD = -2.92, 95% CI [-4.02, -1.83], P < 0.00001), serum amylase concentration (SMD = -2.83, 95% CI [-4.07, -1.60], P < 0.00001), and urine amylase concentration (SMD = -2.34, 95% CI [-3.81, -0.88], P < 0.00001) were lower compared with control group. There was no statistically significant difference in the incidence of adverse reactions between the experimental and control groups.

Conclusions: The combination of octreotide and ulinastatin can improve the intestinal mucosal barrier function, reduce inflammatory response, and decrease amylase levels in patients with acute pancreatitis, without increasing the incidence of adverse reactions. It has significant therapeutic effects and can be promoted as a treatment option for acute pancreatitis in China.