Acute Pancreatitis Associated with Interferon and Ribavirin Therapy in Patients with Chronic Hepatitis C

Acute pancreatitis is a rare complication of interferon (IFN) and ribavirin (RBV) therapy. The aimof this study was to determine the incidence, clinical presentation, and outcome of acute pancreatitisin patients with chronic hepatitis C virus (HCV) infection treated with IFN and RBV combinationtherapy. We conducted a retrospective review of 1706 HCV-infected patients treated with IFN α-2band RBV. The diagnosis of drug-induced acute pancreatitis was made based on the presence ofepigastric pain, elevated amylase and lipase levels, and the absence of other identifiable causes ofpancreatitis. Acute pancreatitis was diagnosed in 7 of 1706 HCV-infected patients (0.4%; 95% CI,0.2 to 0.8%) who were treated with IFN α-2b and RBV. The mean age of the patients (four malesand three females) was 51.4 ± 4.7 years and the median duration of therapy prior to developmentof pancreatitis was 12.0 weeks (range, 4.0-21.0 weeks). All patients presented with epigastric painassociated with nausea, vomiting, and/or fever. The median amylase and lipase values at the timeof diagnosis of pancreatitis were 330.0 U/L (range, 182.0-1813.0 U/L) and 500.0 U/L (range,171.0-2778.0 U/L), respectively. IFN and RBV were discontinued in all patients at the time ofdiagnosis and six of the seven patients were hospitalized; one patient refused hospital admission.Pancreatitis resolved in all seven patients and none of these individuals had recurrent pancreatitisduring a median follow-up of 18.0 months (range, 3.0-27.0 months). In conclusion, IFN and RBVcombination therapy is a potential cause of drug-induced pancreatitis in patients with chronic HCV.In these individuals, pancreatitis is often severe enough to warrant hospital admission, althoughsymptoms resolve promptly after discontinuation of antiviral therapy.