Kensuke Kubota1, Terumi Kamisawa2, Kenji Hirano3, Yoshiki Hirooka4, Kazushige Uchida5, Tsukasa Ikeura5, Hideyuki Shiomi6, Hirotaka Ohara7, Kyoko Shimizu8, Norikazu Arakura9, Atsushi Kanno10, Junichi Sakagami11, Takao Itoi12, Tetsuhide Ito13, Toshiharu Ueki14, Takayoshi Nishino15, Kazuo Inui16, Nobumasa Mizuno17, Hitoshi Yoshida18, Masanori Sugiyama19, Eisuke Iwasaki20, Atsushi Irisawa21, Kazuichi Okazaki5, Shigeyuki Kawa9, Toru Shimosegawa10, Yoshifumi Takeyama22, Tsutomu Chiba23. 1. Department of Endoscopy, Yokohama City University Hospital, Yokohama, Kanagawa, Japan. 2. Department of Internal Medicine, Tokyo Komagome Metropolitan Hospital, Tokyo, Japan. 3. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Department of Endoscopy, Nagoya University Hospital, Nagoya, Aichi, Japan. 5. Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka, Japan. 6. Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan. 7. Department of Community-based Medical Education, Nagoya City University Graduate School of Medicine, Nagoya, Aichi, Japan. 8. Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 9. Department of Gastroenterology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan. 10. Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 11. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 12. Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan. 13. Department of Medicine and Bioregulatory Science, Graduate School of Medicine, Kyushu University, Fukuoka, Japan. 14. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan. 15. Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Hospital, Tokyo, Japan. 16. Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Toyoake, Aichi, Japan. 17. Department of Gastroenterology, Aichi Cancer Center, Nagoya, Aichi, Japan. 18. Department of Gastroenterology, Showa University School of Medicine, Tokyo, Japan. 19. Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan. 20. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Tokyo, Japan. 21. Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan. 22. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan. 23. Department of Gastroenterology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Abstract
BACKGROUND: Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIP patients with hesitation for steroid treatment. METHODS: We collected clinical data for AIP patients from high-volume centers in Japan. Data for AIP patients with and those without steroid treatment (steroid treatment vs. wait and see policy or W&S) were then compared. The primary point was the relapse-free survival rate (RFS) in patients with and those without steroid treatment, as determined using Kaplan-Meier curve. The secondary point was the identification of predictors of remission and risks of relapse in AIP patients without steroid treatment. RESULTS: There were 510 AIP patients in the steroid treatment group and 97 patients in the W&S group. Overall, 55.7% (54/97) of type 1 AIP patients in the W&S group experienced transient remission without steroid treatment. The W&S group had a significantly higher patient age and significantly lower incidences of jaundice, diffuse pancreas swelling, proximal-type sclerosing cholangitis, and stent placement and a lower remission rate than the steroid treatment group (each P < 0.05). The RFS reached a plateau at 10 years in both the W&S group (50%) and steroid treatment group (52.9%). As for the RFS (W&S vs. group with steroid), 89.4% vs. 74.4% within 3 years, 81.8% vs. 65.3% within 5 years, and 50% vs. 52.9% within 10 years (log-rank, P = 0.064). Female gender (OR 0.340, P = 0.027) and stent placement for jaundice (OR 4.552, P = 0.008) were identified as predictors of transient remission in the W&S group. New-onset diabetes mellitus (OR 8.333, P = 0.012) and the presence of extensive multi-organ involvement (OR 35, P = 0.006) were identified as risks of relapse in the W&S group. CONCLUSION: Some type 1 AIP patients without steroid treatment experience transient remission. These cases tend to have lower disease activities than AIP patients receiving steroids. Female gender and stent placement for jaundice may be predictors of transient remission among patients not receiving steroid treatment, however, relapses can occur in these patients with new-onset diabetes mellitus and the presence of extensive multi-organ involvement. Therefore, steroid treatment is still imperative for these patients.
BACKGROUND:Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIPpatients with hesitation for steroid treatment. METHODS: We collected clinical data for AIPpatients from high-volume centers in Japan. Data for AIPpatients with and those without steroid treatment (steroid treatment vs. wait and see policy or W&S) were then compared. The primary point was the relapse-free survival rate (RFS) in patients with and those without steroid treatment, as determined using Kaplan-Meier curve. The secondary point was the identification of predictors of remission and risks of relapse in AIPpatients without steroid treatment. RESULTS: There were 510 AIPpatients in the steroid treatment group and 97 patients in the W&S group. Overall, 55.7% (54/97) of type 1 AIPpatients in the W&S group experienced transient remission without steroid treatment. The W&S group had a significantly higher patient age and significantly lower incidences of jaundice, diffuse pancreas swelling, proximal-type sclerosing cholangitis, and stent placement and a lower remission rate than the steroid treatment group (each P < 0.05). The RFS reached a plateau at 10 years in both the W&S group (50%) and steroid treatment group (52.9%). As for the RFS (W&S vs. group with steroid), 89.4% vs. 74.4% within 3 years, 81.8% vs. 65.3% within 5 years, and 50% vs. 52.9% within 10 years (log-rank, P = 0.064). Female gender (OR 0.340, P = 0.027) and stent placement for jaundice (OR 4.552, P = 0.008) were identified as predictors of transient remission in the W&S group. New-onset diabetes mellitus (OR 8.333, P = 0.012) and the presence of extensive multi-organ involvement (OR 35, P = 0.006) were identified as risks of relapse in the W&S group. CONCLUSION: Some type 1 AIPpatients without steroid treatment experience transient remission. These cases tend to have lower disease activities than AIPpatients receiving steroids. Female gender and stent placement for jaundice may be predictors of transient remission among patients not receiving steroid treatment, however, relapses can occur in these patients with new-onset diabetes mellitus and the presence of extensive multi-organ involvement. Therefore, steroid treatment is still imperative for these patients.
Authors: Sara Nikolic; Patrick Maisonneuve; Ingrid Dahlman; J-Matthias Löhr; Miroslav Vujasinovic Journal: J Clin Med Date: 2022-06-28 Impact factor: 4.964