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Type 1 Autoimmune Pancreatitis in Europe: Clinical Profile and Response to Treatment
KA. Overbeek, JL. Poulsen, M. Lanzillotta, O. Vinge-Holmquist, P. Macinga, AF. Demirci, DP. Sindhunata, J. Backhus, H. Algül, J. Buijs, P. Levy, M. Kiriukova, E. Goni, M. Hollenbach, RC. Miksch, L. Kunovsky, M. Vujasinovic, S. Nikolic, L....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem, multicentrická studie
- MeSH
- autoimunitní pankreatitida * farmakoterapie diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- steroidy terapeutické užití aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND & AIMS: Autoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens. METHODS: We retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals. Type 1 AIP was uniformly diagnosed using specific diagnostic criteria. Patients with type 2 AIP and those who had undergone pancreatic surgery were excluded. The primary end point was complete remission, defined as the absence of clinical symptoms and resolution of the index radiologic pancreatic abnormalities attributed to AIP. RESULTS: We included 735 individuals with AIP (69% male; median age, 57 years; 85% White). Steroid treatment was started in 634 patients, of whom 9 (1%) were lost to follow-up. The remaining 625 had a 79% (496/625) complete, 18% (111/625) partial, and 97% (607/625) cumulative remission rate, whereas 3% (18/625) did not achieve remission. No treatment was given in 95 patients, who had a 61% complete (58/95), 19% partial (18/95), and 80% cumulative (76/95) spontaneous remission rate. Higher (≥0.4 mg/kg/day) corticosteroid doses were no more effective than lower (<0.4 mg/kg/day) doses (odds ratio, 0.428; 95% confidence interval, 0.054-3.387) and neither was a starting dose duration >2 weeks (odds ratio, 0.908; 95% confidence interval, 0.818-1.009). Elevated IgG4 levels were independently associated with a decreased chance of complete remission (odds ratio, 0.639; 95% confidence interval, 0.427-0.955). Relapse occurred in 30% of patients. Relapses within 6 months of remission induction were independent of the steroid-tapering duration, induction treatment duration, and total cumulative dose. CONCLUSIONS: Patients with type 1 AIP and elevated IgG4 level may need closer monitoring. For remission induction, a starting dose of 0.4 mg/kg/day for 2 weeks followed by a short taper period seems effective. This study provides no evidence to support more aggressive regimens.
1 M Sechenov 1st Moscow State Medical University Moscow Russia
Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
Central European Institute of Technology Masaryk University Brno Czech Republic
Department of Digestive Surgery Akershus University Hospital Loerenskog Norway
Department of Digestive Surgery St Olavs Hospital Trondheim University Hospital Trondheim Norway
Department of Gastroenterology and Endocrinology Philipps University Marburg Marburg Germany
Department of Gastroenterology Istanbul University Istanbul Faculty of Medicine Istanbul Turkey
Department of Internal Medicine 1 Martin Luther University Halle Germany
Department of Internal Medicine 1 University Hospital Schleswig Holstein Kiel Germany
Department of Internal Medicine 1 University Hospital Ulm Ulm Germany
Department of Internal Medicine Marmara University Research and Education Hospital Istanbul Turkey
Department of Medicine 2 Technische Universität München München Germany
Department of Medicine 2 University Hospital Ludwig Maximilian University Munich Munich Germany
Department of Medicine A University Medicine Greifswald Greifswald Germany
Department of Outpatient Therapy and Family Medicine Tver State Medical University Tver Russia
Department of Upper Abdominal Diseases Karolinska University Hospital Stockholm Sweden
Division of Pancreatic Diseases Heart and Vascular Centre Semmelweis University Budapest Hungary
Faculty of Medicine Campus Ahus University of Oslo Oslo Norway
Gastrointestinal Endoscopy Unit Humanitas Mater Domini Castellanza Italy
HPB Unit Freeman Hospital Newcastle Upon Tyne United Kingdom
Citace poskytuje Crossref.org
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- $a Overbeek, Kasper A $u Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: k.overbeek@erasmusmc.nl
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- $a Type 1 Autoimmune Pancreatitis in Europe: Clinical Profile and Response to Treatment / $c KA. Overbeek, JL. Poulsen, M. Lanzillotta, O. Vinge-Holmquist, P. Macinga, AF. Demirci, DP. Sindhunata, J. Backhus, H. Algül, J. Buijs, P. Levy, M. Kiriukova, E. Goni, M. Hollenbach, RC. Miksch, L. Kunovsky, M. Vujasinovic, S. Nikolic, L. Dickerson, M. Hirth, MF. Neurath, M. Zumblick, J. Vila, M. Jalal, G. Beyer, F. Frost, S. Carrara, Z. Kala, P. Jabandziev, G. Sisman, F. Akyuz, G. Capurso, M. Falconi, A. Arlt, FP. Vleggaar, L. Barresi, B. Greenhalf, L. Czakó, P. Hegyi, A. Hopper, MK. Nayar, TM. Gress, F. Vitali, A. Schneider, CM. Halloran, J. Trna, AV. Okhlobystin, L. Dagna, DL. Cahen, D. Bordin, V. Rebours, J. Mayerle, A. Kahraman, S. Rasch, E. Culver, A. Kleger, E. Martínez-Moneo, O. Røkke, T. Hucl, SS. Olesen, MJ. Bruno, E. Della-Torre, U. Beuers, JM. Löhr, J. Rosendahl, PrescrAIP Study Group
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- $a BACKGROUND & AIMS: Autoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens. METHODS: We retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals. Type 1 AIP was uniformly diagnosed using specific diagnostic criteria. Patients with type 2 AIP and those who had undergone pancreatic surgery were excluded. The primary end point was complete remission, defined as the absence of clinical symptoms and resolution of the index radiologic pancreatic abnormalities attributed to AIP. RESULTS: We included 735 individuals with AIP (69% male; median age, 57 years; 85% White). Steroid treatment was started in 634 patients, of whom 9 (1%) were lost to follow-up. The remaining 625 had a 79% (496/625) complete, 18% (111/625) partial, and 97% (607/625) cumulative remission rate, whereas 3% (18/625) did not achieve remission. No treatment was given in 95 patients, who had a 61% complete (58/95), 19% partial (18/95), and 80% cumulative (76/95) spontaneous remission rate. Higher (≥0.4 mg/kg/day) corticosteroid doses were no more effective than lower (<0.4 mg/kg/day) doses (odds ratio, 0.428; 95% confidence interval, 0.054-3.387) and neither was a starting dose duration >2 weeks (odds ratio, 0.908; 95% confidence interval, 0.818-1.009). Elevated IgG4 levels were independently associated with a decreased chance of complete remission (odds ratio, 0.639; 95% confidence interval, 0.427-0.955). Relapse occurred in 30% of patients. Relapses within 6 months of remission induction were independent of the steroid-tapering duration, induction treatment duration, and total cumulative dose. CONCLUSIONS: Patients with type 1 AIP and elevated IgG4 level may need closer monitoring. For remission induction, a starting dose of 0.4 mg/kg/day for 2 weeks followed by a short taper period seems effective. This study provides no evidence to support more aggressive regimens.
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- $a Poulsen, Jakob L $u Centre for Pancreatic Diseases, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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- $a Lanzillotta, Marco $u Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
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- $a Macinga, Peter $u Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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