Adjunctive gabexate mesylate with octreotide and clinical outcomes in older adults with acute pancreatitis: a retrospective study

Background Acute pancreatitis (AP) in older adults is associated with higher risks of systemic inflammatory response, organ dysfunction, and prolonged clinical recovery. Pharmacologic interventions targeting early protease activation and exocrine pancreatic secretion may have therapeutic value in this population; however, evidence in elderly patients remains limited. Methods This retrospective study included 220 adults aged ≥60 years hospitalized with AP between July 2021 and July 2025. Among them, 108 received octreotide plus gabexate mesylate and 112 received octreotide monotherapy. Primary outcomes were times to abdominal pain relief, pancreatic enzyme normalization, and gastrointestinal recovery. Multiple linear and multivariable logistic regression models were used to adjust for prespecified demographic and clinical covariates. Results Combination therapy was associated with shorter times to abdominal pain relief (adjusted mean difference −0.95 days; 95% confidence interval [CI] −1.28 to −0.62), pancreatic enzyme normalization (−1.28 days; 95% CI, −1.67 to −0.89), gastrointestinal recovery (−0.86 days; 95% CI −1.25 to −0.47), and hospital discharge (−1.62 days; 95% CI, −2.47 to −0.77; all P ≤ 0.001). It was also associated with higher odds of radiological improvement among re-imaged patients (adjusted odds ratio [OR], 1.82; 95% CI, 1.16–2.86) and lower odds of new-onset or persistent systemic inflammatory response syndrome (adjusted OR, 0.61; 95% CI, 0.38–0.98) and infectious complications (adjusted OR, 0.54; 95% CI, 0.29–0.99). Drug-related adverse events, composite organ dysfunction, mortality, and readmission did not differ significantly. No treatment-by-severity interaction was identified. Conclusion Adjunctive gabexate mesylate was associated with modestly faster short-term recovery in older adults with acute pancreatitis, without a significant increase in drug-related adverse events. Its effects on organ dysfunction and mortality remain uncertain and require confirmation in prospective randomized studies.