Journal of gastroenterology and hepatology · 2025
Clinical Profile and Predictors of Repeated Relapse in Type 1 Autoimmune Pancreatitis: A Multicenter Observational Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Saeki Sho, Ishii Yasutaka, Hanada Keiji, Sasaki Tamito, Fujimoto Yoshifumi, Yamaguchi Atsushi, Hirao Ken, Noma Bunjiro, Minami Tomoyuki, Okazaki Akihito, Yukutake Masanobu, Mouri Teruo, Kawamura Ryota, Nakamura Shinya, Ikemoto Juri, Furukawa Masaru, Oka Shiro
Аннотация
BACKGROUND AND AIM: Type 1 autoimmune pancreatitis (AIP) is a form of pancreatitis that responds well to glucocorticoid therapy and often results in clinical and radiological remission. However, AIP frequently relapses during long-term follow-up. While initial relapse is well described, repeated relapses are poorly understood. This study aimed to clarify their clinical features and predictors.
METHODS: We retrospectively analyzed 270 patients diagnosed with type 1 AIP between 2004 and 2022 across 12 institutions. Clinical characteristics were compared among the non-relapse, single-relapse, and multiple-relapse groups. Predictors of a second relapse were assessed in patients who experienced at least one relapse using Kaplan-Meier and Cox regression analyses.
RESULTS: During a median follow-up of 65 months, 107 patients (40%) experienced at least one relapse, and 32 (12%) had multiple relapses. The median time to second relapse was 49 months, and the cumulative second relapse rate reached 47.4% at 7 years. Multivariable analysis identified extra-pancreatic sclerosing cholangitis at first relapse as an independent predictor of a second relapse (hazard ratio, 2.773; 95% confidence interval, 1.294-5.941; p = 0.009). Furthermore, 61% of patients whose first relapse involved the extra-pancreatic bile duct experienced multiple relapses, often at the same site, and 73% of them were still on glucocorticoid therapy at the second relapse.
CONCLUSIONS: Second and subsequent relapses are common in type 1 AIP, and are particularly likely when the first relapse involves extra-pancreatic sclerosing cholangitis. These patients may require more intensive monitoring and treatment beyond glucocorticoid monotherapy.
METHODS: We retrospectively analyzed 270 patients diagnosed with type 1 AIP between 2004 and 2022 across 12 institutions. Clinical characteristics were compared among the non-relapse, single-relapse, and multiple-relapse groups. Predictors of a second relapse were assessed in patients who experienced at least one relapse using Kaplan-Meier and Cox regression analyses.
RESULTS: During a median follow-up of 65 months, 107 patients (40%) experienced at least one relapse, and 32 (12%) had multiple relapses. The median time to second relapse was 49 months, and the cumulative second relapse rate reached 47.4% at 7 years. Multivariable analysis identified extra-pancreatic sclerosing cholangitis at first relapse as an independent predictor of a second relapse (hazard ratio, 2.773; 95% confidence interval, 1.294-5.941; p = 0.009). Furthermore, 61% of patients whose first relapse involved the extra-pancreatic bile duct experienced multiple relapses, often at the same site, and 73% of them were still on glucocorticoid therapy at the second relapse.
CONCLUSIONS: Second and subsequent relapses are common in type 1 AIP, and are particularly likely when the first relapse involves extra-pancreatic sclerosing cholangitis. These patients may require more intensive monitoring and treatment beyond glucocorticoid monotherapy.