Determination of the duration of glucocorticoid therapy in type 1 autoimmune pancreatitis: A systematic review and meta-analysis.

Published on May 31, 2021in Pancreatology3.629
· DOI :10.1016/J.PAN.2021.05.303
Seung Bae Yoon10
Estimated H-index: 10
(Catholic University of Korea),
Sung-Hoon Moon8
Estimated H-index: 8
(Hallym University)
+ 3 AuthorsMyung-Hwan Kim89
Estimated H-index: 89
(UOU: University of Ulsan)
Sources
Abstract
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 literature review up until November 30, 2020, and identified 40 studies reporting AIP relapse rates. The pooled relapse rates were compared between groups according to the protocol and duration of glucocorticoids (routine vs. no MGT; glucocorticoids ≤6 months vs. 6–12 months vs. 12–36 months vs. ≥ 36 months). The pooled rates of adverse events related to glucocorticoids were also evaluated. null null null Results null Meta-analysis indicated calculated pooled relapse rates of 46.6% (95% confidence interval (CI), 38.9–54.3%) with glucocorticoids for ≤ 6 months, 44.3% (95% CI, 38.8–49.8%) for 6–12 months, 34.1% (95% CI, 28.6–39.7%) for 12–36 months, and 27.0% (95% CI, 23.4–30.6%) for ≥ 36 months. The rate of relapse was also significantly lower in patients with routine-use protocol of MGT (31.2%; 95% CI, 27.5–34.8%) than in patients with no MGT protocol (44.1%; 95% CI, 35.8–52.4%). Adverse events were comparable between groups. null null null Conclusions null The rate of relapse tended to decrease with extended durations of glucocorticoid therapy up to 36 months. Clinicians may decide the duration of glucocorticoids according to patient condition, including comorbidities and risk of relapse.
References67
Newest
#1Ayami Fukiage (Hiroshima University)H-Index: 2
#2Hatsue Fujino (Hiroshima University)H-Index: 14
Last. Kazuaki Chayama (Hiroshima University)H-Index: 124
view all 10 authors...
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...
2 CitationsSource
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...
1 CitationsSource
#1Takuya Ishikawa (Nagoya University)H-Index: 14
#2Hiroki Kawashima (Nagoya University)H-Index: 27
Last. Mitsuhiro Fujishiro (Nagoya University)H-Index: 64
view all 14 authors...
BACKGROUND AND AIM We examined the differences in the risks and characteristics of pancreatic relapse (PR) and pancreatic cancer (PC) in patients with autoimmune pancreatitis (AIP). METHODS We retrospectively reviewed 123 type 1 AIP patients with a median follow-up of 55 months (interquartile range, 27-98). The following items were evaluated: 1) cumulative relapse rates and risk factors, 2) the incidence of PC, 3) PR versus PC, and 4) outcomes after the appearance of morphological changes in the...
5 CitationsSource
#1Yasuhiro Kuraishi (Shinshu University)H-Index: 4
#2Takeshi Uehara (Shinshu University)H-Index: 26
Last. Shigeyuki Kawa (Matsumoto Dental University)H-Index: 67
view all 7 authors...
Abstract Background/objectives Patients with autoimmune pancreatitis (AIP) sometimes progress to chronic pancreatitis (CP). We evaluated the ability of corticosteroids to prevent the progression to CP. Methods We defined patients with definitive findings of CP (stones in the main pancreatic duct [MPD] or multiple pancreatic calcifications) as having severe calcification (SC). A total of 145 AIP patients were enrolled. We measured the duration between AIP diagnosis and SC development and retrospe...
4 CitationsSource
#1J-Matthias Löhr (Karolinska University Hospital)H-Index: 11
#2Ulrich Beuers (UvA: University of Amsterdam)H-Index: 78
Last. Heiko Witt (TUM: Technische Universität München)H-Index: 44
view all 35 authors...
The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, ...
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#1Luca Barresi (ISMETT)H-Index: 22
#2Matteo Tacelli (ISMETT)H-Index: 5
Last. EndoscopistsH-Index: 1
view all 29 authors...
BackgroundAutoimmune pancreatitis (AIP) is a rare, and relatively new, form of chronic pancreatitis. The management of AIP can vary considerably among different centres in daily clinical practice.O...
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#1Corrado Campochiaro (UniSR: Vita-Salute San Raffaele University)H-Index: 23
#2Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 27
Last. Lorenzo Dagna (UniSR: Vita-Salute San Raffaele University)H-Index: 37
view all 10 authors...
Abstract Background IgG4-Related Disease (IgG4-RD) promptly responds to glucocorticoids but relapses in most patients. Rituximab (RTX) represents a promising strategy to avoid IgG4-RD flares but its administration for maintaining disease remission has never been assessed in terms of optimal timing of infusion, dosage, and duration of treatment. In the present study we aimed to evaluate the efficacy and safety of RTX for maintenance of IgG4-RD remission. Methods Fourteen patients with IgG4-RD wer...
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#1Atsushi Masamune (Tohoku University)H-Index: 67
#2Kazuhiro Kikuta (Tohoku University)H-Index: 32
Last. Kazuichi Okazaki (Kansai Medical University)H-Index: 85
view all 7 authors...
Background To further clarify the clinico-epidemiological features of autoimmune pancreatitis (AIP) in Japan, we conducted the fourth nationwide epidemiological survey.
28 CitationsSource
#1Liang Zhu (Peking Union Medical College Hospital)H-Index: 7
#2Huadan Xue (Peking Union Medical College Hospital)H-Index: 22
Last. Zhengyu Jin (Peking Union Medical College Hospital)H-Index: 26
view all 11 authors...
Abstract Purpose To evaluate the imaging pattern of pancreaticobiliary lesions in patients with treated type 1AIP, to determine the incidence of disease relapse and malignancy, and to identify the risk factors. Method The institutional review board approval was acquired. All patients gave written informed consent. From a prospective clinico-radiological database since 2012, consecutive patients with type 1 AIP who were treated and followed up (≥18 months) were identified. The presence/absence of...
5 CitationsSource
Autoimmune pancreatitis (AIP) is an entity that has been recognized since 1961. Prior to the discovery of elevated serum IgG4 as a useful biomarker for its diagnosis, Dr. Yoshida in 1995 first described the entity of AIP, which in retrospect closely resembles the current concept of type 1 AIP. Since the discovery of IgG4 as a biomarker (the IgG4-era), a novel concept of IgG4-related disease (IgG4-RD) has been accepted as being comprised of two subtypes of AIP: type 1 defined as the pancreatic ma...
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Cited By1
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#1Sara Nikolic (KI: Karolinska Institutet)H-Index: 2
#2Nikola Panic (Karolinska University Hospital)H-Index: 13
Last. Miroslav Vujasinovic (Karolinska University Hospital)H-Index: 13
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INTRODUCTION Autoimmune pancreatitis (AIP) is a special form of pancreatitis that responds well to glucocorticoid (GC) treatment. Relapses of AIP are common. The anti-CD20 antibody rituximab (RTX) has shown promising results in GC refractory cases, but long-term data are scarce. The study aims to determine the clinical and imaging response to RTX and summarize the existing data on RTX therapy in patients with AIP type 1 in the literature. PATIENTS AND METHODS Retrospective analysis of electronic...
Source
#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 16
#2Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 27
Last. Gabriele Capurso (UniSR: Vita-Salute San Raffaele University)H-Index: 56
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Abstract null null Background null Type I autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC) belong to the IgG4-related disease (IgG4-RD) spectrum. Both entities respond to glucocorticoids, but iatrogenic toxicity associated with prolonged steroid therapy and relapse represent relevant clinical concerns in the long-term. Rituximab is increasingly used as an effective alternative strategy to induce remission but data regarding the safety and efficacy of B-cell depleti...
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