Safety and efficacy of vitamin-based antioxidant therapy in patients with severe acute pancreatitis: a randomized controlled trial

ABSTRACT

Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxidant therapy in the form of high-dose vitamin has been used for the treatment of severe acute pancreatitis with equivocal results. We wished to evaluate the efficacy and safety of antioxidant [vitamin A, vitamin C, vitamin E] therapy in patients with severe acute pancreatitis. Setting and design: This was a single-center, prospective, randomized, open-label with blinded endpoint assessment study of antioxidant therapy, conducted in the emergency department attached to our hospital. Thirty-nine patients with severe acute pancreatitis were randomly assigned to antioxidant treatment group [n=19] or a control group [n=20] within 96 hours of developing symptoms. Patients in the antioxidant group received antioxidants [vitamin A, vitamin E, vitamin C] in addition to the standard treatment provided to both the groups for a period of 14 days. The primary outcome variable was presence of organ dysfunction at day 7. The secondary outcome variables were length of hospital stay, multiorgan dysfunction [MODS] at day 7, recovery at the end of 4 weeks, complications, and mortality. The change in markers of oxidative stress from baseline was also measured. We demonstrated no significant difference in organ dysfunction [P=1.0], MODS [P=0.8], and length of hospital stay [P=0.29] between the two groups. All the patients survived in the antioxidant-treated group, whereas two patients died in the control group. The change in the levels of malondialdehyde, superoxide dismutase, and reduced glutathione were not significantly different in the two groups at day 7. Univariate analysis showed marginal benefit with antioxidant treatment [P=0.034] in patients with severe acute pancreatitis. This randomized study demonstrates that there is no significant benefit from antioxidant therapy in patients with established severe acute pancreatitis