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Outcome of Long-term Maintenance Steroid Therapy Cessation in Patients With Autoimmune Pancreatitis
- Source :
- Journal of Clinical Gastroenterology. 50:331-337
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- To predict the duration of steroid maintenance therapy required to achieve good prognosis in patients with autoimmune pancreatitis.The study sample comprised 21 patients with autoimmune pancreatitis who met the following criteria: (1) they received steroid therapy (ST) for at least 3 years without clinical relapse; and (2) immunoglobulin (Ig) G1600 mg/dL was observed in the past year with a prednisolone maintenance dose ≤5 mg. All patients could be diagnosed with international consensus diagnostic criteria. Patients were prospectively followed up after tapering and cessation of steroids. Clinical relapse was defined as the need to resume ST. Serological relapse was defined as having an IgG level of1600 mg/dL.During the 43-month (range, 19 to 48 mo) follow-up period, clinical relapse occurred in 10 patients: pancreatic lesion in 4; coronary lesion in 2; submandibular lesion in 1; both pulmonary and renal lesions in 1; pulmonary, retroperitoneal, and submandibular lesions in 1; and bronchial asthma in 1. Serological relapse was observed in 12 patients. Although clinical and serological relapse occurred concomitantly in 3 patients, serological relapse preceded clinical relapse in 4 patients. Five patients experienced serological relapse alone, and no clinical or serological relapse occurred in 6 patients. According to Cox proportional hazard analysis, the duration of ST before tapering was a significant predictive parameter (hazard ratio, 0.969/month; 95% confidence interval, 0.940-0.998; P=0.038).ST cessation resulted in a high rate of clinical relapses, even in patients with long-term maintenance therapy. Therefore, it appears desirable to continue steroid maintenance therapy for a period3 years to prevent relapse.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Anti-Inflammatory Agents
Kaplan-Meier Estimate
Gastroenterology
Drug Administration Schedule
Autoimmune Diseases
Lesion
03 medical and health sciences
0302 clinical medicine
Maintenance therapy
Recurrence
Risk Factors
Internal medicine
medicine
Humans
Prospective Studies
Prospective cohort study
Aged
Proportional Hazards Models
Asthma
Autoimmune pancreatitis
Chi-Square Distribution
business.industry
Proportional hazards model
Remission Induction
Hazard ratio
Middle Aged
medicine.disease
Surgery
Treatment Outcome
Pancreatitis
030220 oncology & carcinogenesis
Female
Steroids
030211 gastroenterology & hepatology
medicine.symptom
business
Chi-squared distribution
Biomarkers
Subjects
Details
- ISSN :
- 01920790
- Volume :
- 50
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Gastroenterology
- Accession number :
- edsair.doi.dedup.....6367e1b5111fcdd21f7ded6232c7f984