International consensus for the treatment of autoimmune pancreatitis

Published on Jan 1, 2017in Pancreatology3.629
· DOI :10.1016/J.PAN.2016.12.003
Kazuichi Okazaki85
Estimated H-index: 85
(Kansai Medical University),
Suresh T. Chari103
Estimated H-index: 103
(Mayo Clinic)
+ 8 AuthorsTooru Shimosegawa95
Estimated H-index: 95
(Tohoku University)
Sources
Abstract
Abstract Background and aims The International Consensus Diagnostic Criteria (ICDC) for AIP has proposed two distinctive type of AIP, type 1 and type 2, and enabled us first to differentiate two types of AIP each other. By initial steroid treatment for induction of remission, remission can be successfully induced in almost all subjects with type 1 and type 2 AIP. As relapse rate in type 1 AIP is significantly higher than in type 2 AIP, there has been ongoing debate on how to treat effectively relapse of type 1 AIP. Methods By a modified Delphi approach, a panel of international experts has proposed an international consensus on the treatment of AIP after intense discussion and deliberation during an international consensus symposium of the International Association of Pancreatology (IAP) 2016. Results Individual statements for nine clinical questions with recommendation levels and the therapeutic strategy have been proposed. Conclusion The recommendations are based on the available evidence, and eastern and western experts' opinions to find standard treatment of AIP worldwide. These recommendations can be tailored according to the local expertise and context in the management of individual patients.
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References43
Newest
#1Atsushi Masamune (Tohoku University)H-Index: 67
#2Isao NishimoriH-Index: 55
Last. Tooru Shimosegawa (Tohoku University)H-Index: 28
view all 29 authors...
Objective Corticosteroid has been established as the standard therapy for autoimmune pancreatitis (AIP), but the requirement for maintenance corticosteroid therapy is controversial. We conducted a randomised controlled trial to clarify the efficacy of maintenance corticosteroid therapy in patients with AIP. Design We conducted a multicentre, tertiary setting, randomised controlled trial. After the induction of remission with the initial oral prednisolone (PSL) treatment, maintenance therapy with...
77 CitationsSource
#1Yan Bi (Mayo Clinic)H-Index: 12
#2Phil A. Hart (OSU: Ohio State University)H-Index: 29
Last. Suresh T. Chari (Mayo Clinic)H-Index: 103
view all 16 authors...
Abstract Objective Autoimmune pancreatitis (AIP) responds dramatically to corticosteroids treatment. We reviewed our experience to determine the safety and effectiveness of treating obstructive jaundice in definitive AIP with corticosteroids alone without biliary stenting. Methods From our AIP database, we retrospectively identified type 1 AIP subjects whose jaundice was treated with corticosteroids alone without biliary stenting. Their medical records were reviewed and clinical data were evalua...
18 CitationsSource
#1Jorie Buijs (Erasmus University Medical Center)H-Index: 6
#2D.L. Cahen (UvA: University of Amsterdam)H-Index: 2
Last. Marco J. BrunoH-Index: 67
view all 13 authors...
textabstractObjective To evaluate the long-term outcome of autoimmune pancreatitis. Methods Patients with at least 2 years of follow-up were included. Information was collected regarding disease characteristics, treatment outcome, diagnosed malignancies, and mortality. In addition, pancreatic function and quality of life were assessed prospectively. Results 107 patients were included (87% men, 90% with type 1), with a median follow-up of 74 (interquartile range, 49-108) months. One third was ope...
20 CitationsSource
#1Mitsuru Sugimoto (Fukushima Medical University)H-Index: 9
#2Tadayuki Takagi (Fukushima Medical University)H-Index: 19
Last. Hiromasa Ohira (Fukushima Medical University)H-Index: 30
view all 14 authors...
Autoimmune pancreatitis (AIP) is treatable with steroids, but relapse is frequent. The efficacy of steroid pulse therapy has been shown for various autoimmune diseases, but has not become established therapy. In this study, we reviewed the efficacy of steroid pulse therapy in 24 subjects who were diagnosed with AIP type 1 at our hospital. Patient characteristics, time-course of serum IgG4, and the cumulative relapse-free survival rate were compared between patients who received oral steroid ther...
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#1Arezou Khosroshahi (Emory University)H-Index: 31
#2Zachary S. Wallace (Harvard University)H-Index: 27
Last. John H. Stone (Harvard University)H-Index: 94
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A. Khosroshahi, Z. S. Wallace, J. L. Crowe, T. Akamizu, A. Azumi, M. N. Carruthers, S. T. Chari, E. Della-Torre, L. Frulloni, H. Goto, P. A. Hart, T. Kamisawa, S. Kawa, M. Kawano, M. H. Kim, Y. Kodama, K. Kubota, M. M. Lerch, M. L€ ohr, Y. Masaki, S. Matsui, T. Mimori, S. Nakamura, T. Nakazawa, H. Ohara, K. Okazaki, J. H. Ryu, T. Saeki, N. Schleinitz, A. Shimatsu, T. Shimosegawa, H. Takahashi, M. Takahira, A. Tanaka, M. Topazian, H. Umehara, G. J. Webster, T. E. Witzig, M. Yamamoto, W. Zhang, T....
445 CitationsSource
#1Matthew T. Huggett (UCL: University College London)H-Index: 6
#2Emma L. Culver (John Radcliffe Hospital)H-Index: 17
Last. Eleanor BarnesH-Index: 57
view all 11 authors...
Type 1 Autoimmune Pancreatitis and IgG4-Related Sclerosing Cholangitis Is Associated With Extrapancreatic Organ Failure, Malignancy, and Mortality in a Prospective UK Cohort
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#1Kirsten BoonstraH-Index: 14
#2Emma L. CulverH-Index: 17
Last. Cyriel Y. PonsioenH-Index: 62
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The recent addition of immunoglobulin (Ig)G4-associated cholangitis (IAC), also called IgG4-related sclerosing cholangitis (IRSC), to the spectrum of chronic cholangiopathies has created the clinical need for reliable methods to discriminate between IAC and the more common cholestatic entities, primary (PSC) and secondary sclerosing cholangitis. The current American Association for the Study of Liver Diseases practice guidelines for PSC advise on the measurement of specific Ig (sIg)G4 in PSC pat...
108 CitationsSource
#1Terumi Kamisawa (Tokyo Metropolitan Komagome Hospital)H-Index: 77
#2Kazuichi Okazaki (Kansai Medical University)H-Index: 85
Last. Tooru Shimosegawa (Tohoku University)H-Index: 28
view all 15 authors...
Background In response to the proposal of the international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP) and the Japanese diagnostic criteria in 2011, the 2009 Japanese consensus guidelines for managing AIP required revision.
132 CitationsSource
#1Jorie Buijs (Erasmus University Medical Center)H-Index: 6
Last. Henk R. van BuurenH-Index: 36
view all 13 authors...
textabstractOBJECTIVE: The objective of this study was to compare efficacy of high versus low doses of prednisone for induction of remission in autoimmune pancreatitis (AIP). METHODS: This is a retrospective, multicenter study including patients diagnosed with AIP between May 1992 and August 2011. Clinical, laboratory and imaging findings were assessed before treatment and at 1, 3, and 6 months after starting treatment. RESULTS: A total of 65 patients (57 males; median age, 63 years) were treate...
25 CitationsSource
#1Theresa SchwaigerH-Index: 9
Last. Julia MayerleH-Index: 67
view all 15 authors...
Background Autoimmune pancreatitis (AIP) in humans invariably responds to steroid treatment, but little is known about the underlying pathogenesis and the benefits of alternative treatments. Objective To study the pathogenesis, and the efficacy of alternative immunosuppressant agents in the MRL/Mp mouse model of AIP. Design MRL/Mp mice were pretreated for 4 weeks with polyinosinic:polycytidylic acid to induce AIP. Pancreatic sections of mice genetically deleted for CTLA-4 were analysed. Blockage...
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INTRODUCTION Awareness of IgG4-related disease (IgG4-RD) is increasing worldwide and specialists are now familiar with most of its clinical manifestations and mimickers. IgG4-RD promptly responds to glucocorticoids and repeated courses are typically used to induce and maintain remission because the disease relapses in most patients. If left untreated it can lead to organ dysfunction, organ failure and death. Advancement in our understanding of IgG4-RD pathogenesis is leading to the identificatio...
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