The following is a summary of “Comparative efficacy of therapeutic plasma exchange and insulin in hypertriglyceridemia-induced acute pancreatitis,” published in the August 2024 issue of Gastroenterology by Thanh et al.

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is challenging to treat, with no clear-cut solution. Treatments like therapeutic plasma exchange (TPE) and insulin are used. The TPE aims to reduce serum triglyceride (TG) quickly. However, its effectiveness needs more evidence. 

Researchers conducted a retrospective study comparing the effectiveness of TPE and intravenous insulin in managing HTG-AP. 

They compared TPE and insulin treatments for patients with HTG-AP. The main focus was the percentage reduction in triglycerides within 48 hours of admission.

The results showed 33 patients treated with TPE and 56 with insulin. Patients treated with TPE had more severe conditions initially. Within 24 hours, TPE reduced triglycerides by 62.5% (IQR 51.7-83.3) compared to insulin, reducing 55.7% (IQR 34.2-74.7) (P=0.038). At 48 hours, the reduction was similar between the TPE (81.9%) and insulin (83.6%) groups (P=0.715). Patients treated with TPE had more extended hospital stays (10.0 [IQR 7.0-13.5] days vs. 6.0 [4.0-8.7] days, P=0.001) but similar in-hospital mortality and time to lower triglycerides below 11.3 mmol/L.

Investigators concluded that TPE reduced TG faster than insulin in the first 24 hours for patients with HTG-AP, but both treatments showed similar results after 48 hours. Insulin could be a promising and convenient alternative for carefully selected patients with HTG-AP.

Source: link.springer.com/article/10.1007/s12664-024-01669-0