There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder.
Dr Suresh Chari and colleagues from Minnesota, USA described their experience with treatment of relapses and maintenance of remission using steroid-sparing immunomodulators (IMs) and induction of remission using rituximab.
The research team obtained details of disease relapse and treatment in 116 type 1 type 1 autoimmune pancreatitis patients from clinic visits, medical records and telephone interviews.
The team compared relapse free survival in those treated with immunomodulators versus those treated with steroids alone, assessed patients’ response to rituximab, and identified treatment-related complications.
During a median follow-up of 47 months, 52/116 type 1 autoimmune pancreatitis patients experienced 76 relapse episodes.
|Intolerance of immunomodulators therapy occurred in 45%|
The first relapse was treated with another course of steroids in 24 patients, and with steroids plus immunomodulators in another 27 patients.
Subsequent relapse-free survival until a second relapse was similar in the 2 groups.
The team noted that 38 patients received an immunomodulators for more than 2 months.
Failure or intolerance of immunomodulators therapy occurred in 45%.
The researchers found that 12 patients with steroid or immunomodulators intolerance/resistance were treated with rituximab, an antiCD20 antibody.
The team observed that 83% of patients experienced complete remission and had no relapses while on maintenance therapy.
Treatment-limiting side effects related to rituximab were uncommon.
Dr Chari's team concludes, "In type 1 type 1 autoimmune pancreatitis relapses are common. Relapse-free survival is similar in those treated with steroids plus immunomodulators compared to those treated with steroids alone."
"Nearly half the patients on immunomodulators will relapse during treatment."
"Rituximab is effective in the treatment of both immunomodulator resistant and steroid intolerant patients."