Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients with Autoimmune Pancreatitis: Systematic Review and Meta-analysis

Matteo Tacelli, Ciro Celsa, Bianca Magro, Luca Barresi, Salvatore Guastella, Gabriele Capurso, Luca Frulloni, Giuseppe Cabibbo, Calogero Cammà

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND AIMS: Risk for relapse after induction of remission with steroid therapy has been extensively studied in patients with autoimmune pancreatitis (AIP), but findings are equivocal. We performed a systematic review and meta-analysis were to estimate the rate of rate of AIP following initial remission after steroid treatment and to identify factors associated with relapse.

METHODS: Three reviewers searched MEDLINE, SCOPUS and EMBASE until July 2018 to identify studies of rate of relapse of AIP rate after induction of remission with steroid therapy. A pooled estimate was calculated using DerSimonian and Laird method for a random-effects model. This study was conducted in accordance with PRISMA guidelines RESULTS: Thirty-six studies met the inclusion criteria for meta-analysis. The median follow-up time was 40.8 months. Fifty-two percent of patients were classified as having type 1 AIP. The pooled estimate of relapse rate was 33% (95% CI, 30%-37%). A higher proportion of patients with type 1 AIP had a relapse compared to patients with type 2 AIP (37.5% vs 15.9%; P<.001). We found significant heterogeneity among studies (P<.01). Long-term maintenance therapy with steroid and study quality were independently associated with AIP relapse, after we adjusted for year of publication by multivariate meta-regression.

CONCLUSION: In a systematic review and meta-analysis, we found that a large proportion of patients with AIP successfully treated with steroid induction therapy have a relapse (33%)-particularly patients with type 1 AIP (37%). Maintenance steroid therapy longer than 1 year could reduce risk of relapse. However, data characterizing relapse rate are of limited quality, indicating the need for randomized controlled trials and new immunosuppressive drugs.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
DOIs
Publication statusE-pub ahead of print - Oct 9 2018

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Pancreatitis
Meta-Analysis
Steroids
Recurrence
Remission Induction
Therapeutics
Immunosuppressive Agents
MEDLINE
Publications
Randomized Controlled Trials
Maintenance
Guidelines
Pharmaceutical Preparations

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Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients with Autoimmune Pancreatitis : Systematic Review and Meta-analysis. / Tacelli, Matteo; Celsa, Ciro; Magro, Bianca; Barresi, Luca; Guastella, Salvatore; Capurso, Gabriele; Frulloni, Luca; Cabibbo, Giuseppe; Cammà, Calogero.

In: Clinical Gastroenterology and Hepatology, 09.10.2018.

Research output: Contribution to journalArticle

Tacelli, Matteo ; Celsa, Ciro ; Magro, Bianca ; Barresi, Luca ; Guastella, Salvatore ; Capurso, Gabriele ; Frulloni, Luca ; Cabibbo, Giuseppe ; Cammà, Calogero. / Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients with Autoimmune Pancreatitis : Systematic Review and Meta-analysis. In: Clinical Gastroenterology and Hepatology. 2018.
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title = "Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients with Autoimmune Pancreatitis: Systematic Review and Meta-analysis",
abstract = "BACKGROUND AND AIMS: Risk for relapse after induction of remission with steroid therapy has been extensively studied in patients with autoimmune pancreatitis (AIP), but findings are equivocal. We performed a systematic review and meta-analysis were to estimate the rate of rate of AIP following initial remission after steroid treatment and to identify factors associated with relapse.METHODS: Three reviewers searched MEDLINE, SCOPUS and EMBASE until July 2018 to identify studies of rate of relapse of AIP rate after induction of remission with steroid therapy. A pooled estimate was calculated using DerSimonian and Laird method for a random-effects model. This study was conducted in accordance with PRISMA guidelines RESULTS: Thirty-six studies met the inclusion criteria for meta-analysis. The median follow-up time was 40.8 months. Fifty-two percent of patients were classified as having type 1 AIP. The pooled estimate of relapse rate was 33{\%} (95{\%} CI, 30{\%}-37{\%}). A higher proportion of patients with type 1 AIP had a relapse compared to patients with type 2 AIP (37.5{\%} vs 15.9{\%}; P<.001). We found significant heterogeneity among studies (P<.01). Long-term maintenance therapy with steroid and study quality were independently associated with AIP relapse, after we adjusted for year of publication by multivariate meta-regression.CONCLUSION: In a systematic review and meta-analysis, we found that a large proportion of patients with AIP successfully treated with steroid induction therapy have a relapse (33{\%})-particularly patients with type 1 AIP (37{\%}). Maintenance steroid therapy longer than 1 year could reduce risk of relapse. However, data characterizing relapse rate are of limited quality, indicating the need for randomized controlled trials and new immunosuppressive drugs.",
author = "Matteo Tacelli and Ciro Celsa and Bianca Magro and Luca Barresi and Salvatore Guastella and Gabriele Capurso and Luca Frulloni and Giuseppe Cabibbo and Calogero Camm{\`a}",
note = "Copyright {\circledC} 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "10",
day = "9",
doi = "10.1016/j.cgh.2018.09.051",
language = "English",
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TY - JOUR

T1 - Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients with Autoimmune Pancreatitis

T2 - Systematic Review and Meta-analysis

AU - Tacelli, Matteo

AU - Celsa, Ciro

AU - Magro, Bianca

AU - Barresi, Luca

AU - Guastella, Salvatore

AU - Capurso, Gabriele

AU - Frulloni, Luca

AU - Cabibbo, Giuseppe

AU - Cammà, Calogero

N1 - Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2018/10/9

Y1 - 2018/10/9

N2 - BACKGROUND AND AIMS: Risk for relapse after induction of remission with steroid therapy has been extensively studied in patients with autoimmune pancreatitis (AIP), but findings are equivocal. We performed a systematic review and meta-analysis were to estimate the rate of rate of AIP following initial remission after steroid treatment and to identify factors associated with relapse.METHODS: Three reviewers searched MEDLINE, SCOPUS and EMBASE until July 2018 to identify studies of rate of relapse of AIP rate after induction of remission with steroid therapy. A pooled estimate was calculated using DerSimonian and Laird method for a random-effects model. This study was conducted in accordance with PRISMA guidelines RESULTS: Thirty-six studies met the inclusion criteria for meta-analysis. The median follow-up time was 40.8 months. Fifty-two percent of patients were classified as having type 1 AIP. The pooled estimate of relapse rate was 33% (95% CI, 30%-37%). A higher proportion of patients with type 1 AIP had a relapse compared to patients with type 2 AIP (37.5% vs 15.9%; P<.001). We found significant heterogeneity among studies (P<.01). Long-term maintenance therapy with steroid and study quality were independently associated with AIP relapse, after we adjusted for year of publication by multivariate meta-regression.CONCLUSION: In a systematic review and meta-analysis, we found that a large proportion of patients with AIP successfully treated with steroid induction therapy have a relapse (33%)-particularly patients with type 1 AIP (37%). Maintenance steroid therapy longer than 1 year could reduce risk of relapse. However, data characterizing relapse rate are of limited quality, indicating the need for randomized controlled trials and new immunosuppressive drugs.

AB - BACKGROUND AND AIMS: Risk for relapse after induction of remission with steroid therapy has been extensively studied in patients with autoimmune pancreatitis (AIP), but findings are equivocal. We performed a systematic review and meta-analysis were to estimate the rate of rate of AIP following initial remission after steroid treatment and to identify factors associated with relapse.METHODS: Three reviewers searched MEDLINE, SCOPUS and EMBASE until July 2018 to identify studies of rate of relapse of AIP rate after induction of remission with steroid therapy. A pooled estimate was calculated using DerSimonian and Laird method for a random-effects model. This study was conducted in accordance with PRISMA guidelines RESULTS: Thirty-six studies met the inclusion criteria for meta-analysis. The median follow-up time was 40.8 months. Fifty-two percent of patients were classified as having type 1 AIP. The pooled estimate of relapse rate was 33% (95% CI, 30%-37%). A higher proportion of patients with type 1 AIP had a relapse compared to patients with type 2 AIP (37.5% vs 15.9%; P<.001). We found significant heterogeneity among studies (P<.01). Long-term maintenance therapy with steroid and study quality were independently associated with AIP relapse, after we adjusted for year of publication by multivariate meta-regression.CONCLUSION: In a systematic review and meta-analysis, we found that a large proportion of patients with AIP successfully treated with steroid induction therapy have a relapse (33%)-particularly patients with type 1 AIP (37%). Maintenance steroid therapy longer than 1 year could reduce risk of relapse. However, data characterizing relapse rate are of limited quality, indicating the need for randomized controlled trials and new immunosuppressive drugs.

U2 - 10.1016/j.cgh.2018.09.051

DO - 10.1016/j.cgh.2018.09.051

M3 - Article

C2 - 30312787

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

ER -