Chhaparia Anuj, Hammami Muhammad B, Vareedayah Ashley, Schroeder Katie
Del Med J. 2017 Mar;89(3):90-92.
Eluxadoline has emerged as an effective treatment option for patients with diarrhea- predominant irritable bowel syndrome (IBS-D). It was approved by the Food and Drug Administration (FDA) in May 2015 for treatment of IBS-D. It is a p-opioid receptor agonist and 6-receptor antagonist that acts locally in the gastrointestinal (GI) tract. In recently published phase IlIl IBS-3001 and IBS- 3002 trials, eight patients experienced abdominal pain due to sphincter of Oddi dysfunction (SOD), and one patient had acute pancreatitis, thought to be related to eluxadoline. Here, we describe a patient with eluxadoline- induced pancreatitis, the first case we know of to be reported outside of phase Ill clinical trials. Interestingly, only patients with prior cholecystectomy developed SOD and acute pancreatitis in the IBS 3001/3002 trials which also stands true with our patient. The enthusiasm with the efficacy of this drug should not have clinicians disregard the potential adverse effects, particularly serious ones, such as acute pancreatitis. We expect more cases of eluxadoline-induced pancreatitis and SOD to be reported, and future studies should focus on better understanding this association so as to guide treatment recommendations.
埃卢多啉已成为腹泻型肠易激综合征（IBS-D）患者的一种有效治疗选择。它于2015年5月获得美国食品药品监督管理局（FDA）批准用于治疗IBS-D。它是一种μ-阿片受体激动剂和κ-受体拮抗剂，在胃肠道局部起作用。在最近发表的III期IBS-3001和IBS-3002试验中，有8名患者因奥狄括约肌功能障碍（SOD）出现腹痛，1名患者发生急性胰腺炎，认为与埃卢多啉有关。在此，我们描述一名埃卢多啉诱发胰腺炎的患者，这是我们所知在III期临床试验之外报告的首例病例。有趣的是，在IBS 3001/3002试验中，只有既往接受过胆囊切除术的患者出现SOD和急性胰腺炎，我们的患者也是如此。对这种药物疗效的热情不应使临床医生忽视其潜在的不良反应，尤其是严重的不良反应，如急性胰腺炎。我们预计会有更多埃卢多啉诱发胰腺炎和SOD的病例被报告，未来的研究应专注于更好地理解这种关联，以指导治疗建议。
