Identification of relapse predictors in IgG4-related disease using multivariate analysis of clinical data at the first visit and initial treatment

Yamamoto, Motohisa; Nojima, Masanori; Takahashi, Hiroki; Yokoyama, Yoshihiro; Ishigami, Keiichi; Yajima, Hidetaka; Shimizu, Yoshitaka; Tabeya, Tetsuya; Matsui, Mikiko; Suzuki, Chisako; Naishiro, Yasuyoshi; Takano, Kenichi; Himi, Tetsuo; Imai, Kohzoh; Shinomura, Yasuhisa

doi:10.1093/rheumatology/keu228

Cited by 57 publications

(44 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We have previously shown that serum IgG4 level increases with the number of inflamed regions. 21 It 24 In the present study, no correlation was observed between serum IgG4 level and relapse ( Figure S2). One possible reason was the significant differences of serum IgG4 levels between the involved organs.…”

Section: Discussioncontrasting

confidence: 62%

See 1 more Smart Citation

Relapse patterns and predictors of IgG4‐related diseases involved with autoimmune pancreatitis: A single‐center retrospective study of 115 patients

Minemura

Fujimori

Oono

et al. 2019

J of Digest Diseases

View full text Add to dashboard Cite

Objective Autoimmune pancreatitis is an autoimmune disorder accompanied by clinicopathological manifestations that have been established as immunoglobulin (IgG)4‐related diseases (IgG4‐RD). Other IgG4‐RD are often involved with autoimmune pancreatitis. They sometimes relapse despite a favorable response to steroid therapy. This study aimed to clarify the patterns and risk factors for extrapancreatic relapse. Methods We reviewed the data of 115 patients diagnosed with definite autoimmune pancreatitis type 1 and followed up for > 1 year. We analyzed two items: the timing and pattern of extrapancreatic relapse, and risk factors for relapse with three common manifestations: IgG4‐related sclerosing cholangitis (SC), IgG4‐related dacryoadenitis and sialadenitis (DS), and IgG4‐related retroperitoneal fibrosis (RF). Results Remission was achieved in all patients, except one. The extrapancreatic relapse rates were 11.0%, 19.7%, and 40% within 3, 5, and 10 years, respectively. Of 26 patients with extrapancreatic relapse, nine (34.6%) relapsed with a new IgG4‐RD. Based on multivariate analysis, the interval between symptom onset and steroid initiation, and the presence of RF at onset were significant risk factors for relapse with SC and RF, respectively. Conclusions Our results indicate that they may be various extrapancreatic relapse patterns especially in autoimmune pancreatitis with other organ involvement. Patients with a delayed initiation of steroids or RF at onset should be carefully followed up as high‐risk groups for SC and RF relapse.

show abstract

Section: Discussioncontrasting

confidence: 62%

“…It is unclear whether there is a relationship between serum IgG4 levels and relapse. Although some studies have shown that elevated serum IgG4 levels is a predictor for relapse, others have produced opposite results . In the present study, no correlation was observed between serum IgG4 level and relapse (Figure S2).…”

Section: Discussionmentioning

confidence: 99%

Relapse patterns and predictors of IgG4‐related diseases involved with autoimmune pancreatitis: A single‐center retrospective study of 115 patients

Minemura

Fujimori

Oono

et al. 2019

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

“…We previously identified the relapse predictors in IgG4-RD using multivariate analysis of clinical data at the first visit and initial treatment; they were male sex and younger onset in cases without organ involvement at diagnosis, and low levels of serum IgG4 in cases with organ dysfunction at diagnosis. Autoimmune pancreatitis and low steroid dose at initial treatment also tended to be associated with recurrence [13]. In the present analysis, it was difficult to interpret the results because sex and organ involvement were excluded, but Cluster 3 had features similar to those described above, younger onset, and low levels of serum IgG4.…”

Section: Discussionmentioning

confidence: 61%

Predicting therapeutic response in IgG4-related disease based on cluster analysis

Yamamoto

Takano

Kamekura

et al. 2018

Immunological Medicine

View full text Add to dashboard Cite

To bring the clinical practice of immunoglobulin (Ig)G4-related disease (IgG4-RD) close to personalized medicine, we classified the patient groups and clarified the therapeutic responses of each group. A total of 147 patients enrolled in our registry were classified into four groups by cluster analysis with the software. The therapeutic responses and prognosis of each group were examined. The cluster analysis classified the subjects into four groups: Cluster 1, patients who presented with prominent hypergammaglobulinemia, elevated levels of serum IgG4, and hypocomplementemia; Cluster 2, patients who presented with eosinophilia, elevated concentrations of serum IgG, IgG4, and IgE, and in whom CRP tended to be positive; Cluster 3, patients with younger onset and serum levels of IgG, IgG4, and IgE and peripheral eosinophil counts lower than the other clusters; and Cluster 4, patients with elder onset and low peripheral eosinophil counts. The amounts of glucocorticoid for maintenance treatment were from 5 to 7 mg/d in all groups, but the amounts were significantly greater in Cluster 1 (patients with hypergammaglobulinemia, elevated levels of serum IgG4, and hypocomplementemia) than in Cluster 4 (elder onset patients, relatively low concentrations of peripheral eosinophils). With regard to the use of immunosuppressants and the relapse rate, there were high frequencies in Cluster 1 and Cluster 3 (younger onset patients who presented with mild elevations of serum IgG and IgG4). On the other hand, Cluster 4 showed a low rate of relapse and often could discontinue steroids. The present results suggest that personalized medicine could be provided in IgG4-RD by classifying patients based on their clinical features. ARTICLE HISTORY

show abstract

“…Yamamoto et al analyzed risk factors for the relapse for patients with IgG4-RD and reported that low steroid dose at initial treatment tended to be associated with recurrence. 25 They also suggested that complication with autoimmune pancreatitis and the use of low-dose glucocorticoid at initial induction therapy tended to be associated with relapse in cases with organ involvement. In our study, although the remission rate was similar in high and medium dose groups in the previous 3 months, a higher relapse rate was observed at week 24 in the medium dose group.…”

Section: -13mentioning

confidence: 99%

Efficacy between high and medium doses of glucocorticoid therapy in remission induction of IgG4‐related diseases: a preliminary randomized controlled trial

Chang

Chen

et al. 2017

Int J of Rheum Dis

View full text Add to dashboard Cite

Aim: In order to evaluate the efficacy and safety of high versus medium doses of glucocorticoid therapy in remission induction of immunoglobulin G4-related disease (IgG4-RD), we set up a randomized controlled study.Method: Newly diagnosed IgG4-RD patients were randomly assigned to two groups: high doses of prednisone (0.8-1.0 mg/kg/day) and medium doses (0.5-0.6 mg/kg/day). Patients were assessed at weeks 0, 4, 12 and 24. The primary outcome was the remission rate at week 24. The secondary endpoints included IgG4-RD responder index (IgG4-RD RI), IgG and IgG4 levels.Results: Twenty cases in each group finished the study. At week 24, the total response rates were 95% and 80% in high and medium dose groups, respectively. There was no significant difference between the two groups. IgG4-RD RI reduced from 14.9 to 3.0 in the high dose group, while in the medium dose group it was from 13.1 to 3.2. At week 24, the average level of IgG4 reduced from 1576 to 324 mg/dL and from 1445 to 684 mg/dL in the two groups, respectively. Relapsed patients had higher baseline IgG4-RD RI. There was no severe adverse effect shown in both groups. Conclusion:The effect of remission induction was similar in high and medium glucocorticoid groups. However, patients with more organs involved and higher IgG4-RD RI score at baseline might get more benefit with high dose glucocorticoid for remission induction.

show abstract

Identification of relapse predictors in IgG4-related disease using multivariate analysis of clinical data at the first visit and initial treatment

Abstract: Follow-up is important in cases with recognized risk factors for relapse, including male sex and younger onset in cases without organ damage.

Cited by 57 publications

References 10 publications

Relapse patterns and predictors of IgG4‐related diseases involved with autoimmune pancreatitis: A single‐center retrospective study of 115 patients

Relapse patterns and predictors of IgG4‐related diseases involved with autoimmune pancreatitis: A single‐center retrospective study of 115 patients

Predicting therapeutic response in IgG4-related disease based on cluster analysis

Efficacy between high and medium doses of glucocorticoid therapy in remission induction of IgG4‐related diseases: a preliminary randomized controlled trial

Contact Info

Product

Resources

About