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Steroid therapy still plays a crucial role and could serve as a bridge to the next promising treatments in patients with IgG4-related sclerosing cholangitis: Results of a Japanese Nationwide Study.
Kubota, Kensuke; Kamisawa, Terumi; Nakazawa, Takahiro; Tanaka, Atsushi; Naitoh, Itaru; Takikawa, Hajime; Unno, Michiaki; Kawa, Shigeyuki; Masamune, Atsushi; Nakamura, Seiji; Okazaki, Kazuichi.
Affiliation
  • Kubota K; Endoscopic Unit, Yokohama City University Hospital, Yokohama, Japan.
  • Kamisawa T; Department of Internal Medicine, Tokyo Metropolitan, Komagome Hospital, Tokyo, Japan.
  • Nakazawa T; Department of Gastroenterology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
  • Tanaka A; Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
  • Naitoh I; Department of Gastroenterology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
  • Takikawa H; Faculty of Medical Technology, Teikyo University, Tokyo, Japan.
  • Unno M; Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
  • Kawa S; Department of Internal Medicine, Matsumoto Dental University, Shiojiri, Japan.
  • Masamune A; Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
  • Nakamura S; Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.
  • Okazaki K; Department of Internal Medicine, Kansai Medical University, Kori Hospital, Neyagawa, Japan.
Article in En | MEDLINE | ID: mdl-35460190
OBJECTIVE: The acceptable duration of steroid therapy for patients with IgG4-sclerosing cholangitis (SC) has been under debate. Our aim is to clarify the feasible duration of steroid treatment. DESIGN: We retrospectively reviewed the data of patients with IgG4-SC and analyzed the following: biliary status during the steroid therapy, incidence of remission, relapse, relapse-free survival rate, and steroid-related complications (SRCs). RESULTS: Remission was achieved 99.5% (763/767) of patients who received steroid therapy, while remission rate dropped to 63.6% (78/129) of patients who didn't receive it. Relapse was noted in 19.7% (151/763) of the patients who received steroid. Besides, relapse rate went up 38.4% (30/78) of the counterpart. Normalization of the serum total bilirubin and serum alkaline phosphatase (ALP) levels were achieved at two weeks regardless of biliary drainage. Multivariate analysis identified younger onset, MST less than three years, immunosuppressant, and steroid cessation as independent risk factors for relapse. Steroid-free was achieved in the patients underwent MST only 3.4% over 54 months. SRCs were recorded in a total of 99 patients (12.9%) despite sufficient preemptive medications. Multivariate analysis identified history of malignancy and immunosuppressant as independent risk factors for SRCs. CONCLUSION: Steroid therapy should be continued for no less than three years to reduce the risk of relapse, with use of preemptive measures taken around five years. The biliary drainage might not be mandatory. Steroid as 1st line therapy could serve as a bridge to further promising treatments.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: J Hepatobiliary Pancreat Sci Year: 2022 Document type: Article Affiliation country: Japan Country of publication: Japan

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: J Hepatobiliary Pancreat Sci Year: 2022 Document type: Article Affiliation country: Japan Country of publication: Japan