Analysis of acute pancreatitis caused by multi-acting receptor-targeted antipsychotics using the Japanese claims database.

INTRODUCTION

Multi-acting receptor-targeted antipsychotics (MARTA) like asenapine, olanzapine, quetiapine, and clozapine are second-generation antipsychotics linked to adverse metabolic effects, including weight gain and elevated blood glucose, which may raise the risk of pancreatitis. This study investigates the relationship between MARTA use and pancreatitis using the DeSC claims database in Japan.

METHODS

A sequence symmetry analysis (SSA) was conducted on data from 2014 to 2023, focusing on patients prescribed MARTA agents and diagnosed with pancreatitis. Adjusted Sequence Ratios (ASRs) were used to assess the risk, and the time from MARTA initiation to pancreatitis onset was analyzed.

RESULTS

The use of all MARTA agents was significantly associated with an increased risk of pancreatitis. The ASR was 1.84 (95 % CI: 1.74-1.94) for asenapine, 6.04 (95 % CI: 4.63-7.89) for clozapine, 3.08 (95 % CI: 3.01-3.15) for olanzapine, and 2.31 (95 % CI: 2.27-2.34) for quetiapine. These findings indicate a statistically significant increase in pancreatitis risk following the initiation of MARTA. Additionally, the median time from the start of MARTA therapy to the onset of pancreatitis was 650 days for asenapine, 864.5 days for clozapine, 612 days for olanzapine, and 613 days for quetiapine, suggesting that pancreatitis tends to develop after prolonged use, especially with clozapine.

DISCUSSION: These results highlight the need for careful monitoring of pancreatitis in patients receiving long-term MARTA therapy. In individuals with risk factors such as obesity, diabetes, or dyslipidemia, the use of MARTA should be considered cautiously. Early detection and appropriate management are essential to reduce the risk of serious outcomes.