Drug-induced pancreatic lesions: new drugs, new challenges

Drug-induced pancreatic lesions: new drugs, new challenges

I.A. Oganezova

I.I. Mechnikov North-Western State Medical University, St. Petersburg 

Acute pancreatitis is a life‑threatening disease associated with substantial socio-economic burden and high mortality. Drug-induced pancreatitis is a relatively rare, yet clinically important and, in our view, still underestimated cause of pancreatic inflammation. The reported incidence of acute drug-induced pancreatitis ranges from approximately 5% of all acute pancreatitis cases in adults to up to 24% in children. To date, more than 500 medications have been implicated as potential triggers of acute or chronic pancreatic injury, and this list is continually expanding. However, no universally accepted criteria exist to reliably attribute the onset of pancreatitis to a specific drug. This is primarily due to the plurality of pathogenetic mechanisms involved in drug-induced pancreatic injury and the considerable difficulty of definitively excluding alternative etiologies of pancreatic damage. The pancreatotoxic potential of azathioprine, valproic acid, didanosine, nonsteroidal anti-inflammatory drugs, and several other agents is well established. At the same time, in recent years there has been increasing discussion of adverse pancreatic effects associated with drugs used for the treatment of obesity and diabetes mellitus, as well as monoclonal antibodies. This review was aimed to summarize the available data on the epidemiology, mechanisms of development, and diagnostic patterns of drug-induced pancreatitis, and to draw clinicians’ attention to the potential risks of pancreatotoxicity associated with modern highly active pharmacologic agents.

Keywords: drug-induced pancreatitis, pancreatotoxicity of medicines, immune checkpoint inhibitors, incretins.

For citation: Oganezova I.A. Drug-induced pancreatic lesions: new drugs, new challenges. RMJ. 2025;9:–32. DOI: 10.32364/2225-2282-2025-9-5