Azathioprine Maintenance Therapy to Prevent Relapses in Autoimmune Pancreatitis.

Published on Apr 1, 2015in Clinical and translational gastroenterology3.968
· DOI :10.1038/CTG.2017.17
Nicolò de Pretis8
Estimated H-index: 8
(University of Verona),
Antonio Amodio13
Estimated H-index: 13
(University of Verona)
+ 8 AuthorsLuca Frulloni58
Estimated H-index: 58
(University of Verona)
Sources
Abstract
OBJECTIVES:Steroids are used to induce remission in autoimmune pancreatitis (AIP). Low-dosage steroid therapy or immunosuppressant (IMs) has been proposed as maintenance therapy to prevent AIP relapse. Few and conflicting data have been published on the efficacy of azathioprine (AZA) in preventing A
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References32
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#1Matthew T. Huggett (UCL: University College London)H-Index: 6
#2Emma L. Culver (John Radcliffe Hospital)H-Index: 17
Last. Eleanor BarnesH-Index: 57
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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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#1Phil A. Hart (Mayo Clinic)H-Index: 29
#2Ryan J. Law (Mayo Clinic)H-Index: 2
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ObjectivesThe risk of pancreatic and extrapancreatic cancer in autoimmune pancreatitis (AIP) has not been systematically evaluated. We compared the risk of malignancy in AIP patients and matched control subjects.MethodsWe identified 116 subjects with AIP from a prospectively maintained database. Fro
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Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis. AIP is a relatively new disease entity, which has become a new evolving field in gastroenterology. Its importance and relevance are increasing, especially due to being one important differential diagnosis of pancreatic cancer. Based on an international consensus, AIP is classified into two distinct types: (1) Type 1 AIP appears to be part of a systemic immunoglobulin IgG4-positive disease with lobular, interlobular inflammatio...
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#1Phil A. Hart (Mayo Clinic)H-Index: 29
#2Terumi Kamisawa (Tokyo Metropolitan Komagome Hospital)H-Index: 77
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Objective Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. Design 23 institutions from 10 different countries participated in this multination...
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#1Phil A. Hart (Mayo Clinic)H-Index: 29
#2Mark Topazian (Mayo Clinic)H-Index: 65
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Background There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. Objective We describe our experience with treatment of relapses and maintenance of remission using steroid-sparing immunomodulators (IMs) and induction of remission using rituximab (RTX). Methods We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relaps...
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#1Tsukasa Ikeura (Kansai Medical University)H-Index: 19
#2Riccardo Manfredi (University of Verona)H-Index: 51
Last. Luca Frulloni (University of Verona)H-Index: 58
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Background: International consensus diagnostic criteria (ICDC) have been proposed to classify autoimmune pancreatitis (AIP) in type 1, type 2, or not otherwise specified. Objective: Aim was to apply the ICDC to an Italian series of patients to evaluate the incidence and clinical profiles among different subtypes of AIP. Methods: we re-evaluated and classified 92 patients diagnosed by Verona criteria, according to the ICDC. Results: Out of 92 patients, 59 (64%) were diagnosed as type 1, 17 (18%) ...
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#1Masahiro Shiokawa (Kyoto University)H-Index: 13
#2Yuzo Kodama (Kyoto University)H-Index: 35
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IgG4-related disease (IgG4-RD) is a novel clinical disease entity characterized by an elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4-positive plasma cells. IgG4-RD encompasses a wide variety of diseases, formerly diagnosed as Mikulicz's disease (MD), autoimmune pancreatitis (AIP), hypophysitis, Riedel thyroiditis, tubulointerstitial nephritis, prostatitis, retroperitoneal fibrosis, inflammatory aortic aneurysm and inflammatory pseudotumor. However, like a crow f...
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#1Clancy J. Clark (Wake Forest Baptist Medical Center)H-Index: 20
#2Vicente Morales-Oyarvide (Harvard University)H-Index: 26
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Background Autoimmune pancreatitis (AIP) is a rare subtype of chronic pancreatitis that may mimic adenocarcinoma of the pancreas. The aim of this study was to evaluate the short-term and long-term outcomes of pancreatectomy for patients with AIP.
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#1Sönke Detlefsen (OUH: Odense University Hospital)H-Index: 21
#2Giuseppe Zamboni (University of Verona)H-Index: 81
Last. Günter Klöppel (TUM: Technische Universität München)H-Index: 38
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Abstract Background At the recent consensus conference on autoimmune pancreatitis (AIP) in Honolulu, we presented preliminary data from our study of surgically treated AIP patients. Our data strongly supported the separation of AIP into type 1 and type 2. Our study is based on a total of 114 surgically treated European AIP patients. Our aims were to elucidate serum IgG4 elevation, other organ involvement, relapse of disease, steroid treatment and diabetes after surgery in 114 surgically treated ...
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#1Sushil Kumar GargH-Index: 23
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#1Seung Bae Yoon (Catholic University of Korea)H-Index: 10
#2Sung-Hoon Moon (Hallym University)H-Index: 8
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Abstract null null Background null The indications for maintenance glucocorticoid therapy (MGT) and its duration after initial remission of type 1 autoimmune pancreatitis (AIP) remain controversial. In contrast to the Japanese treatment protocol, the Mayo protocol does not recommend MGT after initial remission. This study aimed to evaluate the relapse rate in patients with type 1 AIP according to the duration of glucocorticoid therapy. null null null Methods null We conducted a systematic litera...
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#1Ayami Fukiage (Hiroshima University)H-Index: 2
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BACKGROUND: Serum IgG4 level is a useful diagnostic marker for autoimmune pancreatitis (AIP), but it is difficult to use to predict relapse. AIMS: We investigated whether serum autotaxin (ATX) level is predictive of AIP relapse after steroid therapy. METHODS: Fifty-six patients with type 1 AIP were investigated. We measured serum ATX at the time of diagnosis. We selected 24 males for whom serum samples during steroid therapy had been obtained and measured serum ATX at steroid therapy for inducti...
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#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 16
#2Andreu Fernández-Codina (UWO: University of Western Ontario)H-Index: 10
Last. Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 27
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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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Objectives: IgG4-related disease (IgG4-RD) is a chronic fibro-inflammatory disorder affecting virtually any organ. Type 1 autoimmune (type 1 AIP) is its pancreatic manifestation. To date, steroids are considered the first-line pancreatitis treatment. The CD20-binding antibody rituximab (RTX) appears a promising steroid-sparing therapy, although long-term data are lacking. We aimed to bridge this gap with a cohort of IgG4-RD patients treated with RTX and to assess the potential value of the Respo...
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Last. Fernando Martínez-ValleH-Index: 9
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IgG4-related disease (IgG4-RD) is an autoimmune fibrosing condition which is being increasingly recognized. This condition has been classically managed with glucocorticoids (GC) with variable dosing and frequent relapses. Multiple observational reports studied different GC doses and steroid-sparing agents. Rituximab (RTX) was reported as an effective induction treatment, with less relapses after 1 year of treatment. In the absence of guidelines, an international management consensus was made in ...
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#1Martin Blaho (University of Ostrava)H-Index: 2
#2Petr Dítě (University of Ostrava)H-Index: 10
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Autoimmune pancreatitis is a rare form of chronic pancreatitis. The first descriptions of the disease date back to the 1990s. Etiology is multifactorial, with the use of genetic, environmental and complex immunological mechanisms. It is classified into two subtypes. Type 1 is part of a group of diseases called IgG4-related disease. Clinically is autoimmune pancreatitis manifested by icterus and abdominal discomfort. It can rarely present as acute pancreatitis. There is also a completely asymptom...
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#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 16
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Introduction: Treatment of autoimmune pancreatitis (AIP) is based solely on consensus and has yet to become standardized. Consequently, therapeutic regimens vary greatly between countries and centres, and largely depend on the experience of the physician. At this moment, the optimal regimen for inducing disease remission and preventing relapse is unknown. Objectives: The primary objective of this study is to describe current treatment regimens used in Europe, and to compare their effectiveness i...
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#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 16
#2Gaia Mancuso (UniSR: Vita-Salute San Raffaele University)H-Index: 3
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ABSTRACT IgG4 related disease was recognized as a unified disease entity only 15 years ago. Awareness of IgG4 related disease has increased worldwide since then, and specialists are now familiar with most of its clinical manifestations. Involvement of the pancreato-biliary tract, retroperitoneum/aorta, head and neck, and salivary glands are the most frequently observed disease phenotypes, differing in epidemiological features, serological findings, and prognostic outcomes. In view of this multif...
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#1Dina Omar (HUST: Huazhong University of Science and Technology)H-Index: 1
#2Yu Chen (HUST: Huazhong University of Science and Technology)H-Index: 5
Last. Lingli Dong (HUST: Huazhong University of Science and Technology)H-Index: 14
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OBJECTIVE: To assess the safety and efficacy of glucocorticoids (GCs), immunosuppressive agents (IM) and rituximab (RTX), alone or in combination, for the treatment of IgG4-RD. METHODS: Relevant articles published were searched in the databases with relevant key words. Network meta-analysis was conducted, with various outcomes including relapse rate, remission rate and adverse events. Data were calculated with odds ratio (ORs) and 95% CI. P-score was used to rank the treatments. RESULTS: A total...
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