Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment

a Japanese multicenter study of 97 patients

Kensuke Kubota, Terumi Kamisawa, Kenji Hirano, Yoshiki Hirooka, Kazushige Uchida, Tsukasa Ikeura, Hideyuki Shiomi, Hirotaka Ohara, Kyoko Shimizu, Norikazu Arakura, Atsushi Kanno, Junichi Sakagami, Takao Itoi, Tetsuhide Ito, Toshiharu Ueki, Takayoshi Nishino, Kazuo Inui, Nobumasa Mizuno, Hitoshi Yoshida, Masanori Sugiyama & 7 others Eisuke Iwasaki, Atsushi Irisawa, Kazuichi Okazaki, Shigeyuki Kawa, Toru Shimosegawa, Yoshifumi Takeyama, Tsutomu Chiba

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)223-230
Number of pages8
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume25
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

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Pancreatitis
Multicenter Studies
Steroids
Therapeutics
Recurrence
Jaundice
Stents
Survival Rate
Diabetes Mellitus
Sclerosing Cholangitis
Autoimmune Diseases
Pancreas
Japan

Keywords

  • Autoimmune pancreatitis
  • Relapse
  • Remission
  • Stent
  • Steroid treatment

ASJC Scopus subject areas

  • Surgery
  • Hepatology

Cite this

Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment : a Japanese multicenter study of 97 patients. / Kubota, Kensuke; Kamisawa, Terumi; Hirano, Kenji; Hirooka, Yoshiki; Uchida, Kazushige; Ikeura, Tsukasa; Shiomi, Hideyuki; Ohara, Hirotaka; Shimizu, Kyoko; Arakura, Norikazu; Kanno, Atsushi; Sakagami, Junichi; Itoi, Takao; Ito, Tetsuhide; Ueki, Toshiharu; Nishino, Takayoshi; Inui, Kazuo; Mizuno, Nobumasa; Yoshida, Hitoshi; Sugiyama, Masanori; Iwasaki, Eisuke; Irisawa, Atsushi; Okazaki, Kazuichi; Kawa, Shigeyuki; Shimosegawa, Toru; Takeyama, Yoshifumi; Chiba, Tsutomu.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 25, No. 4, 01.04.2018, p. 223-230.

Research output: Contribution to journalArticle

Kubota, K, Kamisawa, T, Hirano, K, Hirooka, Y, Uchida, K, Ikeura, T, Shiomi, H, Ohara, H, Shimizu, K, Arakura, N, Kanno, A, Sakagami, J, Itoi, T, Ito, T, Ueki, T, Nishino, T, Inui, K, Mizuno, N, Yoshida, H, Sugiyama, M, Iwasaki, E, Irisawa, A, Okazaki, K, Kawa, S, Shimosegawa, T, Takeyama, Y & Chiba, T 2018, 'Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment: a Japanese multicenter study of 97 patients', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 25, no. 4, pp. 223-230. https://doi.org/10.1002/jhbp.541
Kubota, Kensuke ; Kamisawa, Terumi ; Hirano, Kenji ; Hirooka, Yoshiki ; Uchida, Kazushige ; Ikeura, Tsukasa ; Shiomi, Hideyuki ; Ohara, Hirotaka ; Shimizu, Kyoko ; Arakura, Norikazu ; Kanno, Atsushi ; Sakagami, Junichi ; Itoi, Takao ; Ito, Tetsuhide ; Ueki, Toshiharu ; Nishino, Takayoshi ; Inui, Kazuo ; Mizuno, Nobumasa ; Yoshida, Hitoshi ; Sugiyama, Masanori ; Iwasaki, Eisuke ; Irisawa, Atsushi ; Okazaki, Kazuichi ; Kawa, Shigeyuki ; Shimosegawa, Toru ; Takeyama, Yoshifumi ; Chiba, Tsutomu. / Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment : a Japanese multicenter study of 97 patients. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2018 ; Vol. 25, No. 4. pp. 223-230.
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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.",
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author = "Kensuke Kubota and Terumi Kamisawa and Kenji Hirano and Yoshiki Hirooka and Kazushige Uchida and Tsukasa Ikeura and Hideyuki Shiomi and Hirotaka Ohara and Kyoko Shimizu and Norikazu Arakura and Atsushi Kanno and Junichi Sakagami and Takao Itoi and Tetsuhide Ito and Toshiharu Ueki and Takayoshi Nishino and Kazuo Inui and Nobumasa Mizuno and Hitoshi Yoshida and Masanori Sugiyama and Eisuke Iwasaki and Atsushi Irisawa and Kazuichi Okazaki and Shigeyuki Kawa and Toru Shimosegawa and Yoshifumi Takeyama and Tsutomu Chiba",
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TY - JOUR

T1 - Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment

T2 - a Japanese multicenter study of 97 patients

AU - Kubota, Kensuke

AU - Kamisawa, Terumi

AU - Hirano, Kenji

AU - Hirooka, Yoshiki

AU - Uchida, Kazushige

AU - Ikeura, Tsukasa

AU - Shiomi, Hideyuki

AU - Ohara, Hirotaka

AU - Shimizu, Kyoko

AU - Arakura, Norikazu

AU - Kanno, Atsushi

AU - Sakagami, Junichi

AU - Itoi, Takao

AU - Ito, Tetsuhide

AU - Ueki, Toshiharu

AU - Nishino, Takayoshi

AU - Inui, Kazuo

AU - Mizuno, Nobumasa

AU - Yoshida, Hitoshi

AU - Sugiyama, Masanori

AU - Iwasaki, Eisuke

AU - Irisawa, Atsushi

AU - Okazaki, Kazuichi

AU - Kawa, Shigeyuki

AU - Shimosegawa, Toru

AU - Takeyama, Yoshifumi

AU - Chiba, Tsutomu

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

KW - Autoimmune pancreatitis

KW - Relapse

KW - Remission

KW - Stent

KW - Steroid treatment

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U2 - 10.1002/jhbp.541

DO - 10.1002/jhbp.541

M3 - Article

VL - 25

SP - 223

EP - 230

JO - Journal of Hepato-Biliary-Pancreatic Sciences

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SN - 1868-6974

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