title: Factors predictive of relapse and spontaneous remission of autoimmune pancreatitis patients treated/not treated with corticosteroids.
abstract: BACKGROUND
  Relapse and spontaneous remission (SR) are characteristic features of autoimmune pancreatitis (AIP).
  
  
  OBJECTIVE
  We conducted a study to determine if the predictive factors might be potentially related to the relapse in 70 consecutive AIP patients. Regarding SR, we studied the data of patients without corticosteroid treatment (CST).
  
  
  RESULTS
  CST was administered to 60% (42/70) of the patients; however, relapse was noted in 45.2% (19/42) of these patients. In 95% (18/19) of the AIP patients developing relapse, the relapse occurred within 3 years. The relapse rate was 80% (12/15) in the AIP patients administered CST for less than 12 months and 25.9% (7/27) in those administered CST for over 12 months (p < 0.01). The results of univariate analysis revealed significant association of relapse with the presence of jaundice, IgG4 seropositivity, presence of diffuse pancreas swelling, duodenal papillitis (DP), history of initial CST, and history of supportive treatment (p < 0.05), whereas multivariate analysis revealed that IgG4 seropositivity (OR 10.506, p = 0.0422) and the presence of jaundice (OR 6.945, p = 0.0174) are significant independent factors predictive of relapse in AIP patients. SR was recognized in 65.0% (13/20) of AIP patients without CST. The results of univariate analysis revealed that SR was associated with IgG4 seropositivity (p < 0.05), and multivariate analysis identified IgG4 seropositivity (OR 0.032, p = 0.0092) as a significant independent factor predictive of SR in these cases.
  
  
  CONCLUSIONS
  AIP patients with IgG4 seropositivity and jaundice are at a higher risk of relapse and they could therefore be candidates for over 3 years of maintenance CST. AIP patients with IgG4 seronegativity have a high likelihood of SR.
authors.affiliation: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa, Yokohama 236-0004, Japan. kubotak@yokohama-cu.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Seitaro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sekino
authors.forename: Kaori
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hironori
authors.initials: H
authors.lastname: Mawatari
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Endo
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Kantaro
authors.initials: K
authors.lastname: Hisatomi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sato
authors.forename: Emiko
authors.initials: E
authors.lastname: Tanida
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Fujisawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007565:Jaundice / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D011446:Prospective Studies; D012008:Recurrence; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G