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Cannabinoid-Related Acute Pancreatitis: An Update from International Literature and Individual Case Safety Reports

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Abstract

Introduction

In addition to the growing interest of different cannabinoids for therapeutic purposes, the safety profile of these substances has changed, with the recent identification of new events such as acute pancreatitis.

Objective

The aim of this study was to characterize cannabinoid-related acute pancreatitis, based on the recent literature and the analysis of pharmacovigilance data available worldwide.

Methods

Nine national and international pharmacovigilance databases were requested for individual case safety reports of acute pancreatitis related to cannabinoid exposure. A systematic review was performed searching in PubMed®, Web of Science®, and Google Scholar® for any publication dealing with acute pancreatitis and cannabinoid exposure (cannabis, cannabinoid, cannabidiol, tetrahydrocannabinol, nabilone, dronabinol), to identify case reports, observational studies, clinical trials, or reviews. All queries were updated on 1 January, 2021.

Results

Twenty-two individual case safety reports were identified in the pharmacovigilance databases and 51 in the literature, corresponding to a predominantly young male population (74% of men, median age 28 interquartile range [21–39]) using recreational Cannabis sativa with high intensity. A therapeutic purpose was identified in 13 cases (including tetrahydrocannabinol, cannabidiol, and dronabinol). The outcome was often favorable after dechallenge (except three deaths), and frequent recurrences were observed in the case of rechallenge or sustained consumption. Eleven cross-sectional studies and one ecological study showed an increasing trend of cannabis use in in-patients with acute pancreatitis, with a significantly lower in-hospital mortality.

Conclusions

This review underlines that acute pancreatitis is a potential adverse effect of cannabinoid use. It remains often unrecognized and can occur during recreational or therapeutic use. The development of the therapeutic use of cannabinoids in frail patients deserves a better investigation of the benefit-risk ratio of these different products.

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Authors and Affiliations

  1. Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, CIC 1436, CHU, Université de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France

    Camille Azam & Maryse Lapeyre-Mestre

  2. Service de Gastroentérologie et Pancréatologie, CIC Biotherapies 1436, CHU, Université de Toulouse, Toulouse, France

    Louis Buscail

  3. Service de Gastroentérologie et Pancréatologie, CHU, Université de Toulouse, Toulouse, France

    Adrian Culetto

Authors
  1. Camille Azam
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  2. Louis Buscail
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  3. Adrian Culetto
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  4. Maryse Lapeyre-Mestre
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Corresponding author

Correspondence to Maryse Lapeyre-Mestre.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This work has been conducted in the context of a research master training of Camille Azam at the University of Toulouse.

Conflicts of interest/Competing interests

Camille Azam, Adrian Culetto, and Maryse Lapeyre-Mestre declare that they have no conflict of interest. Louis Buscail has received research grants from CVASTHERA pharmaceutical.

Ethics approval

This study did not required any specific ethics approval, case reports included have been already published in the scientific literature, or are accessible through open or restricted national or international pharmacovigilance databases.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and material

As indicated in the article, data extracted from the open pharmacovigilance databases can be extracted by any individual. Information from databases with a restricted access can be obtained on request from the Uppsala Monitoring Center and/or from national pharmacovigilance centers. All data used and generated in the literature review are presented in the main text of the article or in the ESM. All literature cases are available as published on request.

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Authors’ contributions

MLM had the idea for the article, CA and MLM performed the literature search, data extraction and data analysis, and the pharmacovigilance database search, LB and EC provided their list of references and published case series, CA drafted the first draft, and all authors revised the work and approved the final manuscript.

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Azam, C., Buscail, L., Culetto, A. et al. Cannabinoid-Related Acute Pancreatitis: An Update from International Literature and Individual Case Safety Reports. Drug Saf 45, 215–235 (2022). https://doi.org/10.1007/s40264-022-01146-7

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