Potential Use of Icosapent Ethyl in the Management of Acute Pancreatitis
DOI:
https://doi.org/10.71079/ASIDE.GI.0107256Abstract
Dear Editor,
We are writing to highlight the potential use of Icosapent Ethyl (Vascepa) as a management option for acute pancreatitis. To the best of my knowledge, a limited number of studies have investigated this use, but it is not yet Food and Drug Administration (FDA) approved for this indication.
Previous studies have suggested that omega-3 fatty acids, such as Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA), may have anti-inflammatory properties and could potentially be beneficial in reducing the inflammation and triglyceride levels associated with acute pancreatitis [1]. These mechanisms consist of systemic inflammation reduction by the inhibition of inflammatory mediators since omega-3 fatty acids inhibit the synthesis of pro-inflammatory cytokines such as IL-1β and IL-6 [2]. Moreover, they alter intracellular signaling pathways linked to transcription factors such as nuclear factor-κB, which impacts the expression of genes linked to inflammation [3]. Surprisingly, it helped with inflammation resolution by enhancing the removal of inflammatory cells and promoting the production of certain pro-resolving mediators in mice with pancreatitis [4].
EPA may serve as a valuable dietary supplement for individuals with risk factors for heart disease. It has potential benefits for conditions such as cardiovascular disease, diabetes, obesity, cancer, and stroke. EPA has been shown to lower inflammation, cholesterol, blood pressure, and blood clotting, and improve coronary artery function. Additionally, it can reduce inflammation and enhance body composition, supporting weight loss efforts [5].
A case study reported the use of Icosapent Ethyl as a treatment for severe acute pancreatitis in a 31-year-old male patient with abrupt acute alcoholic pancreatitis, requiring ICU admission, intubation, and mechanical ventilation, renal replacement therapy, and pressors; the patient showed remarkable improvement after initiation of icosapent Ethyl treatment via gastrostomy tube (G-tube) and had a complete recovery [1].
A randomized clinical trial (RCT) by Wang (2008) investigated the impact of omega-3 fatty acid supplementation on inflammation and systemic disease progression in severe acute pancreatitis. 40 patients with severe acute pancreatitis were randomly assigned to receive parenteral nutrition with either soybean oil or fish oil. Results revealed that patients who received fish oil had higher levels of EPA, reduced C-reactive protein (CRP) levels, and improved oxygenation index after five days of treatment. Additionally, the fish oil group had a shorter duration of continuous renal replacement therapy compared to the control group. The study concludes that supplementing parenteral nutrition with omega-3 fatty acids can effectively decrease inflammation, enhance respiratory function, and reduce the need for Continuous Renal Replacement Therapy (CRRT) in severe acute pancreatitis [6].
Currently, treatment options for acute pancreatitis caused by hypertriglyceridemia are limited as there are no FDA-approved options for intractable hyperchylomicronemia. Lifestyle modifications, such as weight loss and dietary intake limitations, are essential in treating patients with hypertriglyceridemia [7].
However, these findings suggest that Vascepa may be a breakthrough therapy for severe acute pancreatitis due to its anti-inflammatory activity and the absence of direct therapy for the disease. More research including RCTs is needed to confirm the safety and efficacy of Vascepa as a management option for acute pancreatitis.
Keywords:
Icosapent Ethyl, Acute Pancreatitis, Eicosapentaenoic Acid , Anti-inflammatory Therapy, Hypertriglyceridemia, Vascepa, Pancreatic Inflammation ManagementFull Text
Letter to the Editor
Dear Editor,
We are writing to highlight the potential use of Icosapent Ethyl (Vascepa) as a management option for acute pancreatitis. To the best of my knowledge, a limited number of studies have investigated this use, but it is not yet Food and Drug Administration (FDA) approved for this indication.
Previous studies have suggested that omega-3 fatty acids, such as Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA), may have anti-inflammatory properties and could potentially be beneficial in reducing the inflammation and triglyceride levels associated with acute pancreatitis [1]. These mechanisms consist of systemic inflammation reduction by the inhibition of inflammatory mediators, since omega-3 fatty acids inhibit the synthesis of pro-inflammatory cytokines such as IL-1β and IL-6 [2]. Moreover, they alter intracellular signaling pathways linked to transcription factors such as nuclear factor-κB, which impacts the expression of genes linked to inflammation [3]. Surprisingly, it helped with inflammation resolution by enhancing the removal of inflammatory cells and promoting the production of certain pro-resolving mediators in mice with pancreatitis [4].
EPA may serve as a valuable dietary supplement for individuals with risk factors for heart disease. It has potential benefits for conditions such as cardiovascular disease, diabetes, obesity, cancer, and stroke. EPA has been shown to lower inflammation, cholesterol, blood pressure, and blood clotting, and improve coronary artery function. Additionally, it can reduce inflammation and enhance body composition, supporting weight loss efforts [5].
A case study reported the use of Icosapent Ethyl as a treatment for severe acute pancreatitis in a 31-year-old male patient with abrupt acute alcoholic pancreatitis, requiring ICU admission, intubation, and mechanical ventilation, renal replacement therapy, and pressors; the patient showed remarkable improvement after initiation of icosapent Ethyl treatment via gastrostomy tube (G-tube) and had a complete recovery [1].
A randomized clinical trial (RCT) by Wang (2008) investigated the impact of omega-3 fatty acid supplementation on inflammation and systemic disease progression in severe acute pancreatitis. 40 patients with severe acute pancreatitis were randomly assigned to receive parenteral nutrition with either soybean oil or fish oil. Results revealed that patients who received fish oil had higher levels of EPA, reduced C-reactive protein (CRP) levels, and improved oxygenation index after five days of treatment. Additionally, the fish oil group had a shorter duration of continuous renal replacement therapy compared to the control group. The study concludes that supplementing parenteral nutrition with omega-3 fatty acids can effectively decrease inflammation, enhance respiratory function, and reduce the need for Continuous Renal Replacement Therapy (CRRT) in severe acute pancreatitis [6].
Currently, treatment options for acute pancreatitis caused by hypertriglyceridemia are limited as there are no FDA-approved options for intractable hyperchylomicronemia. Lifestyle modifications, such as weight loss and dietary intake limitations, are essential in treating patients with hypertriglyceridemia [7].
However, these findings suggest that Vascepa may be a breakthrough therapy for severe acute pancreatitis due to its anti-inflammatory activity and the absence of direct therapy for the disease. More research including RCTs is needed to confirm the safety and efficacy of Vascepa as a management option for acute pancreatitis.
中文摘要
icosapent乙基酯在急性胰腺炎管理中的潜在应用
背景：我们写信强调icosapent乙基酯（Vascepa）作为急性胰腺炎管理选项的潜在用途。据我所知，关于此用途的研究有限，但尚未获得美国食品药品监督管理局（FDA）的批准。
目的：先前研究表明，ω‑3脂肪酸，如二十碳五烯酸（EPA）和二十二碳六烯酸（DHA），可能具有抗炎特性，并可能有助于降低急性胰腺炎相关的炎症和甘油三酯水平[1]。其机制包括通过抑制炎症介质的合成来降低全身炎症，因为ω‑3脂肪酸抑制促炎细胞因子如IL‑1β和IL‑6的合成[2]。此外，它们改变与转录因子如核因子‑κB相关的细胞内信号通路，影响与炎症相关基因的表达[3]。令人惊讶的是，它通过增强炎症细胞的清除和促进某些促消除介质的产生，帮助小鼠胰腺炎的炎症消退[4]。
方法：EPA可作为具有心脏病风险因素个体的有价值膳食补充剂。它对心血管疾病、糖尿病、肥胖、癌症和中风等疾病具有潜在益处。EPA已被证明可降低炎症、胆固醇、血压和血液凝固，并改善冠状动脉功能。此外，它还能降低炎症并改善体成分，支持减重努力[5]。
结果：一项病例研究报道了在一名31岁男性急性酒精性胰腺炎患者中使用icosapent乙基酯治疗重度急性胰腺炎，该患者需要ICU入住、插管和机械通气、肾替代治疗和升压药；在通过胃造瘘管（G‑tube）开始icosapent乙基酯治疗后，患者表现出显著改善并完全康复[1]。
结果：一项由Wang（2008）进行的随机临床试验（RCT）研究了ω‑3脂肪酸补充对重度急性胰腺炎炎症和系统性疾病进展的影响。40名重度急性胰腺炎患者被随机分配接受含大豆油或鱼油的静脉营养。结果显示，接受鱼油的患者EPA水平更高，C‑反应蛋白（CRP）水平降低，五天治疗后氧合指数改善。此外，鱼油组的连续肾替代治疗（CRRT）持续时间比对照组更短。该研究得出结论，补充含ω‑3脂肪酸的静脉营养可有效降低炎症、改善呼吸功能，并减少重度急性胰腺炎中CRRT的需求[6]。
结论：目前，因高甘油三酯导致的急性胰腺炎的治疗选择有限，因为尚无FDA批准的针对难治性高乳糜微粒血症的治疗方案。生活方式改变，如减重和饮食限制，对治疗高甘油三酯患者至关重要[7]。然而，这些发现表明Vascepa可能是重度急性胰腺炎的突破性疗法，因其抗炎活性且缺乏针对该疾病的直接治疗。需要更多包括RCT在内的研究来确认Vascepa作为急性胰腺炎管理选项的安全性和有效性。
本中文摘要为机器辅助翻译，仅供参考；以英文摘要为准。 Machine-assisted Chinese translation of the English abstract; the English abstract is the version of record.
References
1. Berger AA, Sherburne R, Urits I, Patel H, Eskander J. Icosapent Ethyl (Vascepa(R)) for the Treatment of Acute, Severe Pancreatitis. Cureus. 2020;12(11):e11551. [PMID: 33365220, PMCID: PMC7748593, https://doi.org/10.7759/cureus.11551].
2. Krupa KN, Fritz K, Parmar M. In: Omega-3 Fatty Acids. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025. [PMID: 33231984].
3. Surette ME. The science behind dietary omega-3 fatty acids. CMAJ. 2008;178(2):177-80. [PMID: 18195292, PMCID: PMC2174995, https://doi.org/10.1503/cmaj.071356].
4. Weylandt KH, Nadolny A, Kahlke L, Kohnke T, Schmocker C, Wang J, Lauwers GY, Glickman JN, Kang JX. Reduction of inflammation and chronic tissue damage by omega-3 fatty acids in fat-1 transgenic mice with pancreatitis. Biochim Biophys Acta. 2008;1782(11):634-41. [PMID: 18832028, PMCID: PMC2614880, https://doi.org/10.1016/j.bbadis.2008.08.011].
5. Nassar M, Jaffery A, Ibrahim B, Baraka B, Abosheaishaa H. The multidimensional benefits of eicosapentaenoic acid: from heart health to inflammatory control. The Egyptian Journal of Internal Medicine. 2023;35(1):81. [https://doi.org/10.1186/s43162-023-00265-6].
6. Wang X, Li W, Li N, Li J. Omega-3 fatty acids-supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: a randomized and controlled study. JPEN J Parenter Enteral Nutr. 2008;32(3):236-41. [PMID: 18443134, https://doi.org/10.1177/0148607108316189].
7. Guerriero T, St James C. A rare case of severe hypertriglyceridemia in a patient with no acute pancreatitis after previous bouts of pancreatitis secondary to hypertriglyceridemia. Journal of Clinical and Translational Endocrinology: Case Reports. 2022;23:100102. [https://doi.org/10.1016/j.jecr.2021.100102].
Data Availability Statement
All data supporting the findings of this study are included within the article. No additional datasets were generated or analyzed.
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Copyright (c) 2025 Hazem Abosheaishaa, Mahmoud Nassar
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Article history
- Received
- 5 Nov 2024
- Received in revised form
- 17 Dec 2024
- Accepted
- 20 Dec 2024
- Published
- 7 Jan 2025
