Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients With Autoimmune Pancreatitis: Systematic Review and Meta-analysis

Published on May 1, 2019in Clinical Gastroenterology and Hepatology11.382
· DOI :10.1016/J.CGH.2018.09.051
Matteo Tacelli7
Estimated H-index: 7
(University of Palermo),
Ciro Celsa10
Estimated H-index: 10
(University of Palermo)
+ 6 AuthorsCalogero Cammà77
Estimated H-index: 77
(University of Palermo)
Sources
Abstract
Background & Aims Risk for relapse after induction of remission with steroid therapy has been studied extensively in patients with autoimmune pancreatitis (AIP), but findings have been equivocal. We performed a systematic review and meta-analysis to estimate the relapse rate of AIP after initial remission after steroid treatment and to identify factors associated with relapse. Methods Three reviewers searched MEDLINE, SCOPUS, and EMBASE until July 2018 to identify studies on rate of relapse of AIP after induction of remission with steroid therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random-effects model. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Thirty-six studies met the inclusion criteria for meta-analysis. The median follow-up time was 40.8 months. Fifty-two percent of patients were classified as having type 1 AIP. The pooled estimate of relapse rate was 33% (95% CI, 30%–37%). A higher proportion of patients with type 1 AIP had a relapse compared with patients with type 2 AIP (37.5% vs 15.9%; P Conclusions In a systematic review and meta-analysis, we found that a large proportion of patients with AIP treated successfully with steroid induction therapy had a relapse (33%)—particularly patients with type 1 AIP (37%). Maintenance steroid therapy lasting longer than 1 year could reduce risk of relapse. However, the data characterizing relapse rates are of limited quality, indicating the need for randomized controlled trials and new immunosuppressive drugs.
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#1Surinder Singh Rana (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 27
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#10Dong Wan Seo (UOU: University of Ulsan)H-Index: 70
Background Type 1 autoimmune pancreatitis (AIP), as a pancreatic manifestation of IgG4-related disease, shows a favorable prognosis in the short term. However, disease relapse is common in long-term follow-up, despite a successful initial treatment response. This study aimed to identify the predictors of relapse and long-term outcomes in patients with type 1 AIP.
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#2J.-Matthias LöhrH-Index: 20
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#1Martin Blaho (University of Ostrava)H-Index: 3
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