Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis

Masamune, Atsushi; Nishimori, Isao; Kikuta, Kazuhiro; Tsuji, Ichiro; Mizuno, Nobumasa; Iiyama, Tatsuo; Kanno, Atsushi; Tachibana, Yuichi; Ito, Tetsuhide; Kamisawa, Terumi; Uchida, Kazushige; Hamano, Hideaki; Yasuda, Hiroaki; Sato, Junichi; Mitoro, Akira; Taguchi, Masashi; Kihara, Yasuyuki; Sugimoto, Hiroyuki; Hirooka, Yoshiki; Yamamoto, Satoshi; Inui, Kentaro; Inatomi, Osamu; Andoh, Akira; Nakahara, Kazuyuki; Miyakawa, Hiroyoshi; Hamada, Shin; Kawa, Shigeyuki; Okazaki, Kazuichi; Shimosegawa, Tooru

doi:10.1136/gutjnl-2016-312049

Cited by 165 publications

(110 citation statements)

References 33 publications

(50 reference statements)

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“…However, a recent randomized controlled study showed significantly higher relapse rates in the "stopprednisolone-group" (57.9%) as compared to the "maintenance-therapy-group" (23%) in which no steroid-associated side effects were found [46], clearly supporting maintenance therapy (Fig. 2).…”

Section: Steroidsmentioning

confidence: 85%

IgG4-Related Diseases in the Gastrointestinal Tract: Clinical Presentation, Diagnosis and Treatment Challenges

et al. 2018

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Background: IgG4-related diseases are a rare but an important entity. Due to the variable clinical presentation, this multiorgan disease was attributed to single-organ systems for many years. Also, it often remains a challenge to differentiate between IgG4-related diseases and malignancies. The pathogenesis seems to be a mixture of Th1- and Th2- immune responses, whereas the role of the non-pathogenic IgG4 antibodies is still unclear. Histopathological characteristics are a lymphoplasmacellular infiltrate with IgG4+ plasma cells, a storiform fibrosis and an obliterative phlebitis. This can lead to the functional destruction of every organ affected. In most cases, glucocorticoid treatment leads to remission and is used as maintenance therapy as well. Immune modulatory therapies are employed in case of steroid resistance. However, a majority of patients achieve remission without any therapy. Summary: In this study, we review the current state-of-the-art regarding pathophysiology, diagnostics, organ manifestation and therapeutic approaches. Key Messages: While the diagnosis of IgG4-related diseases is still challenging, there have been significant improvements in diagnostic as well as in therapeutic approaches. This is partially due to a better understanding of the pathophysiology of the disease but also due to improved imaging modalities and novel, more targeted therapies.

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Section: Steroidsmentioning

confidence: 85%

IgG4-Related Diseases in the Gastrointestinal Tract: Clinical Presentation, Diagnosis and Treatment Challenges

et al. 2018

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“…From a serological point of view, pathogenesis of AIP can be attributed to autoimmunity, as indicated by specific serologic abnormalities and the dramatic response to steroid therapy[20]. AIP patients show high incidences of hypergammaglobulinemia (43%), increased levels of IgG (62–80%), IgG4 (68–92%) and antinuclear antibodies (40–64%), rheumatoid factor (25%) [14, 21, 22].…”

Section: Discussionmentioning

confidence: 99%

Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin

Yan

Chen

et al. 2017

PLoS ONE

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Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which may be misdiagnosed as pancreatic carcinoma. This study aims to verify new biomarkers for AIP and propose a serological pattern to differentiate AIP from pancreatic adenocarcinoma with routinely performed tests. In this study, data of serum samples were collected and compared between 25 patients with AIP and 100 patients with pancreatic carcinoma. Receiver operating characteristic analysis and logistic regression was performed to evaluate the diagnostic effect of serum parameters in differentiating AIP from pancreatic carcinoma alone or in combination. Among several serum markers observed in the two groups, carbohydrate antigen 19–9 (Ca19-9), globulin, eosinophils and hemoglobin were selected as the independent markers. Serum levels of Globulin, Eosinophil percentage in AIP group were significantly higher than in pancreatic cancer group (P<0.05), while hemoglobin and tumor marker CA19-9 levels were lower (P <0.05). The combination of these markers identified patients with AIP with 92% sensitivity and 79% specificity, which indicated relatively high diagnostic value. Elevated serum eosinophils, globulin, together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to initiate diagnosis of AIP in time.

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“…We read with great interest the article by Masamune et al 1 regarding the role of long-term maintenance corticosteroids in patients with autoimmune pancreatitis (AIP) 1. AIP is a steroid responsive disorder, which has two distinct entities with overlapping features, classified as type I and type II AIP.…”

mentioning

confidence: 99%