Risk factors and treatment of relapses in autoimmune pancreatitis: Rituximab is safe and effective.

Abstract

Background and aims:

Steroid therapy is the first-line treatment for autoimmune pancreatitis but relapses are frequent. The aims were to assess the efficacy and the safety of immunomodulator treatments for relapsing autoimmune pancreatitis and rituximab in particular and to identify relapsing risk factors.

Methods:

Patients followed for autoimmune pancreatitis from 2000 to 2016 were included. Data were retrospectively analysed regarding autoimmune pancreatitis treatment.

Results:

In total, 162 patients with autoimmune pancreatitis type 1 (n = 92) and type 2 (n = 70) were included (median follow-up: 3 years (0.5-14). Relapse occurred in 46.5% of patients with autoimmune pancreatitis type 1 (vs 19.3% in autoimmune pancreatitis 2; p < 0.001). Risk factors of relapse were cholangitis, initial use of steroids, other organ involvement and chronic pancreatitis in autoimmune pancreatitis type 1 and initial use of steroids, tobacco consumption and chronic pancreatitis for autoimmune pancreatitis type 2. Overall, 21 patients were treated with immunomodulators (azathioprine, n = 19, or methotrexate, n = 2) for relapses. The efficiency rate was 67%. A total of 17 patients were treated with rituximab, with two perfusions at 15 days apart. The efficacy was 94% (16/17), significantly better than immunomodulator drugs (p = 0.03), with a median follow-up of 20 months (11-44). Only two patients needed two supplementary perfusions.

Conclusion:

In relapsing autoimmune pancreatitis, rituximab is more efficient than immunomodulator drugs and shows better tolerance.

• Authors: Heithem Soliman, Marie-Pierre Vullierme, Frédérique Maire, Olivia Hentic, Philippe Ruszniewski, Philippe Lévy, Vinciane Rebours
• Journal: United European gastroenterology journal (United European Gastroenterol J) Vol. 7 Issue 8 Pg. 1073-1083 (10 2019) ISSN: 2050-6406 [Print] England
• PMID: 31662864 (Publication Type: Comparative Study, Journal Article)
• Copyright: © Author(s) 2019.

Chemical References

• Immunologic Factors
• Steroids
• Rituximab
• Azathioprine
• Methotrexate

Topics

• Adult
• Aged
• Autoimmune Diseases (blood, drug therapy)
• Autoimmune Pancreatitis (classification, diagnosis, drug therapy)
• Azathioprine (therapeutic use)
• Cholangitis (drug therapy, epidemiology)
• Female
• Humans
• Immunoglobulin G4-Related Disease (blood, drug therapy)
• Immunologic Factors (administration & dosage, therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Pancreatitis, Chronic (drug therapy, epidemiology)
• Perfusion (methods)
• Recurrence
• Retrospective Studies
• Risk Factors
• Rituximab (administration & dosage, therapeutic use)
• Safety
• Steroids (therapeutic use)
• Treatment Outcome