Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab

The Mayo Clinic experience

Phil A. Hart, Mark Topazian, Thomas Elmer Witzig, Jonathan E. Clain, Ferga C. Gleeson, Robin R. Klebig, Michael J. Levy, Randall K. Pearson, Bret Thomas Petersen, Thomas Christopher Smyrk, Aravind Sugumar, Naoki Takahashi, Santhi Swaroop Vege, Suresh T Chari

Research output: Contribution to journalArticle

201 Citations (Scopus)

Abstract

Background There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. Objective: We describe our experience with treatment of relapses and maintenance of remission using steroidsparing immunomodulators (IMs) and induction of remission using rituximab (RTX). Methods: We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relapse free survival in those treated with IMs versus those treated with steroids alone, assessed patients' response to RTX, and identified treatment-related complications. Results: During a median follow-up of 47 months, 52/116 AIP patients experienced 76 relapse episodes. The first relapse was treated with another course of steroids in 24 patients, and with steroids plus IM in another 27 patients; subsequent relapse-free survival until a second relapse was similar in the two groups (p=0.23). 38 patients received an IM for >2 months; failure or intolerance of IM therapy occurred in 17 (45%). 12 patients with steroid or IM intolerance/resistance were treated with RTX, an antiCD20 antibody; 10 (83%) experienced complete remission and had no relapses while on maintenance therapy. Treatment-limiting side effects related to RTX were uncommon. Conclusions: In type 1 AIP relapses are common. Relapse-free survival is similar in those treated with steroids plus IM compared to those treated with steroids alone. Nearly half the patients on IMs will relapse during treatment. RTX is effective in the treatment of both IM resistant and steroid intolerant patients.

Original languageEnglish (US)
Pages (from-to)1607-1615
Number of pages9
JournalGut
Volume62
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Immunologic Factors
Pancreatitis
Recurrence
Steroids
Therapeutics
Survival
Rituximab
Remission Induction
Ambulatory Care
Medical Records
Maintenance
Interviews

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab : The Mayo Clinic experience. / Hart, Phil A.; Topazian, Mark; Witzig, Thomas Elmer; Clain, Jonathan E.; Gleeson, Ferga C.; Klebig, Robin R.; Levy, Michael J.; Pearson, Randall K.; Petersen, Bret Thomas; Smyrk, Thomas Christopher; Sugumar, Aravind; Takahashi, Naoki; Vege, Santhi Swaroop; Chari, Suresh T.

In: Gut, Vol. 62, No. 11, 11.2013, p. 1607-1615.

Research output: Contribution to journalArticle

Hart, PA, Topazian, M, Witzig, TE, Clain, JE, Gleeson, FC, Klebig, RR, Levy, MJ, Pearson, RK, Petersen, BT, Smyrk, TC, Sugumar, A, Takahashi, N, Vege, SS & Chari, ST 2013, 'Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: The Mayo Clinic experience', Gut, vol. 62, no. 11, pp. 1607-1615. https://doi.org/10.1136/gutjnl-2012-302886
Hart, Phil A. ; Topazian, Mark ; Witzig, Thomas Elmer ; Clain, Jonathan E. ; Gleeson, Ferga C. ; Klebig, Robin R. ; Levy, Michael J. ; Pearson, Randall K. ; Petersen, Bret Thomas ; Smyrk, Thomas Christopher ; Sugumar, Aravind ; Takahashi, Naoki ; Vege, Santhi Swaroop ; Chari, Suresh T. / Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab : The Mayo Clinic experience. In: Gut. 2013 ; Vol. 62, No. 11. pp. 1607-1615.
@article{28cb054d75274370b428762a68dcc65d,
title = "Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: The Mayo Clinic experience",
abstract = "Background There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. Objective: We describe our experience with treatment of relapses and maintenance of remission using steroidsparing immunomodulators (IMs) and induction of remission using rituximab (RTX). Methods: We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relapse free survival in those treated with IMs versus those treated with steroids alone, assessed patients' response to RTX, and identified treatment-related complications. Results: During a median follow-up of 47 months, 52/116 AIP patients experienced 76 relapse episodes. The first relapse was treated with another course of steroids in 24 patients, and with steroids plus IM in another 27 patients; subsequent relapse-free survival until a second relapse was similar in the two groups (p=0.23). 38 patients received an IM for >2 months; failure or intolerance of IM therapy occurred in 17 (45{\%}). 12 patients with steroid or IM intolerance/resistance were treated with RTX, an antiCD20 antibody; 10 (83{\%}) experienced complete remission and had no relapses while on maintenance therapy. Treatment-limiting side effects related to RTX were uncommon. Conclusions: In type 1 AIP relapses are common. Relapse-free survival is similar in those treated with steroids plus IM compared to those treated with steroids alone. Nearly half the patients on IMs will relapse during treatment. RTX is effective in the treatment of both IM resistant and steroid intolerant patients.",
author = "Hart, {Phil A.} and Mark Topazian and Witzig, {Thomas Elmer} and Clain, {Jonathan E.} and Gleeson, {Ferga C.} and Klebig, {Robin R.} and Levy, {Michael J.} and Pearson, {Randall K.} and Petersen, {Bret Thomas} and Smyrk, {Thomas Christopher} and Aravind Sugumar and Naoki Takahashi and Vege, {Santhi Swaroop} and Chari, {Suresh T}",
year = "2013",
month = "11",
doi = "10.1136/gutjnl-2012-302886",
language = "English (US)",
volume = "62",
pages = "1607--1615",
journal = "Gut",
issn = "0017-5749",
publisher = "BMJ Publishing Group",
number = "11",

}

TY - JOUR

T1 - Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab

T2 - The Mayo Clinic experience

AU - Hart, Phil A.

AU - Topazian, Mark

AU - Witzig, Thomas Elmer

AU - Clain, Jonathan E.

AU - Gleeson, Ferga C.

AU - Klebig, Robin R.

AU - Levy, Michael J.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Smyrk, Thomas Christopher

AU - Sugumar, Aravind

AU - Takahashi, Naoki

AU - Vege, Santhi Swaroop

AU - Chari, Suresh T

PY - 2013/11

Y1 - 2013/11

N2 - Background There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. Objective: We describe our experience with treatment of relapses and maintenance of remission using steroidsparing immunomodulators (IMs) and induction of remission using rituximab (RTX). Methods: We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relapse free survival in those treated with IMs versus those treated with steroids alone, assessed patients' response to RTX, and identified treatment-related complications. Results: During a median follow-up of 47 months, 52/116 AIP patients experienced 76 relapse episodes. The first relapse was treated with another course of steroids in 24 patients, and with steroids plus IM in another 27 patients; subsequent relapse-free survival until a second relapse was similar in the two groups (p=0.23). 38 patients received an IM for >2 months; failure or intolerance of IM therapy occurred in 17 (45%). 12 patients with steroid or IM intolerance/resistance were treated with RTX, an antiCD20 antibody; 10 (83%) experienced complete remission and had no relapses while on maintenance therapy. Treatment-limiting side effects related to RTX were uncommon. Conclusions: In type 1 AIP relapses are common. Relapse-free survival is similar in those treated with steroids plus IM compared to those treated with steroids alone. Nearly half the patients on IMs will relapse during treatment. RTX is effective in the treatment of both IM resistant and steroid intolerant patients.

AB - Background There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. Objective: We describe our experience with treatment of relapses and maintenance of remission using steroidsparing immunomodulators (IMs) and induction of remission using rituximab (RTX). Methods: We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relapse free survival in those treated with IMs versus those treated with steroids alone, assessed patients' response to RTX, and identified treatment-related complications. Results: During a median follow-up of 47 months, 52/116 AIP patients experienced 76 relapse episodes. The first relapse was treated with another course of steroids in 24 patients, and with steroids plus IM in another 27 patients; subsequent relapse-free survival until a second relapse was similar in the two groups (p=0.23). 38 patients received an IM for >2 months; failure or intolerance of IM therapy occurred in 17 (45%). 12 patients with steroid or IM intolerance/resistance were treated with RTX, an antiCD20 antibody; 10 (83%) experienced complete remission and had no relapses while on maintenance therapy. Treatment-limiting side effects related to RTX were uncommon. Conclusions: In type 1 AIP relapses are common. Relapse-free survival is similar in those treated with steroids plus IM compared to those treated with steroids alone. Nearly half the patients on IMs will relapse during treatment. RTX is effective in the treatment of both IM resistant and steroid intolerant patients.

UR - http://www.scopus.com/inward/record.url?scp=84885579114&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885579114&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2012-302886

DO - 10.1136/gutjnl-2012-302886

M3 - Article

VL - 62

SP - 1607

EP - 1615

JO - Gut

JF - Gut

SN - 0017-5749

IS - 11

ER -