Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment

Abstract

Objectives: Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis, and has a favourable response to corticosteroid treatment (CST). Little is known, however, about the long-term outcome of AIP. This study aimed to document the prognosis without and with CST, and to examine the indication for CST. Patients and methods: The prognosis and clinical features of 23 patients without CST and 19 patients treated with CST from onset were investigated. In addition, factors concerning the late occurrence of unfavourable events related to AIP were examined. Results: The patients without CST were 19 men and four women, with an average age of 66 years. After an average observation period of 25 months, 16 patients (70%) developed unfavourable events including obstructive jaundice as a result of distal bile duct stenosis in four, growing pseudocyst in one, sclerogenic changes of extrapancreatic bile duct in nine, hydronephrosis as a result of retroperitoneal fibrosis in one, and interstitial nephritis in one. Patients with obstructive jaundice at onset showed a higher cumulative event occurrence rate (p = 0.025). The patients treated with CST were 16 men and three women, with an average age of 64 years. After an average observation period of 23 months, six patients (32%) developed unfavourable events consisting of interstitial pneumonia in three, and a recurrence of obstructive jaundice in three. In multivariate analysis, CST (HR 0.33, 95% CI 0.12-0.89, p = 0.029) and obstructive jaundice at onset (HR 3.09, 95% CI 1.14-8.32, p = 0.026) were significant predictive factors for unfavourable events. Conclusion: CST could reduce AIP-related unfavourable events. The early introduction of CST is recommended especially for patients with obstructive jaundice.

Autoimmune Pancreatitis Associated with Various Extrapancreatic Lesions during a Long-term Clinical Course Successfully Treated with Azathioprine and Corticosteroid Maintenance Therapy

“…However, some patients with AIP relapse during the clinical course. Steroid is generally used for maintenance therapy and is useful for preventing relapse (11,12). Recently, some studies have reported the usefulness of azathioprine for the clinical management of relapse in patients with AIP (13,14).…”

Pancreatitis crónica autoinmune

“…Las series publicadas comprenden periodos de tiempo limitados con un número reducido de pacientes (62,(66)(67)(68)(69).…”

“…Se ha observado que en los pacientes tratados con corticoides la recurrencia de los síntomas se ha producido del 10 al 40% de los casos, necesitando volver a tratar (67) y en algunos casos ha obligado a mantener el tratamiento con dosis más reducidas (37,63,(67)(68)(69).…”

“…(67), en un estudio retrospectivo sobre pacientes tratados con corticosteroides (16 casos) y sin este tratamiento (19 casos), constatan que tras un seguimiento medio de 25 meses los pacientes sin tratamiento habían desarrollado diferentes incidentes desfavorables en el 70% de ellos, en forma de ictericia obstructiva, molestias abdominales, colangitis, fibrosis retroperitoneal, nefritis e hidronefrosis. En los enfermos tratados con corticosteroides los diferentes incidentes desfavorables se redujeron al 32%.…”

The Therapeutic Strategy for Autoimmune Pancreatitis Is Subject to Endoscopic Features of the Duodenal Papilla

“…A tendency towards a marked decrease in the stainability of FOXP3-positive lymphocytes and IgG4-positive plasma cells in the duodenal papilla after corticosteroid administration as compared with that before the therapy was observed in each case [Kubota et al 2009a]. AIP cases showed a relapse rate of around 20 45% [Kamisawa et al 2009;Hirano et al 2007;Kubota et al 2007b]. The need to maintain steroid therapy to reduce relapse for AIP was indicated.…”