Treatment Approaches in Autoimmune Pancreatitis (Review)

Overview

Journal Biomed Rep

Specialty Biochemistry

Date 2024 Jan 23

PMID 38259589

Authors

Vlad Padureanu

Alice Nicoleta Dragoescu

Rodica Padureanu

Maria Magdalena Rosu

Dumitru Radulescu

Dalia Dop

Mircea Catalin For Ofoiu

Affiliations

Soon will be listed here.

Abstract

Autoimmune pancreatitis (AIP) is a rare disease. There are two distinct types of AIP: AIP type 1 (AIP-1), a pancreatic manifestation of a multi-organ disease linked to immunoglobulin (Ig)G4, and AIP type 2 (AIP-2), a pancreas-specific disease unrelated to IgG4. The usual course of treatment for AIP is oral corticosteroid medication. Rituximab has also been recommended for recurrent AIP-1 in order to initiate remission and provide ongoing treatment. Immunomodulators such as azathioprine are used to keep certain patients in remission. Evaluation also takes into account a number of pharmacological alternatives, including biologic drugs like anti-tumor necrosis factor therapy, a safe and efficient second-line treatment for AIP-2 relapse or steroid dependence. Corticosteroids and immunosuppressants, which are poorly tolerated due to considerable side effects, are being replaced by other biologic drugs, which may offer a beneficial therapeutic alternative.

Citing Articles

Autoimmune Pancreatitis Mimicking Obstructive Pancreatic Neuroendocrine Tumor.

Haddadin R, Grewal A, Patel S, Merhavy Z, Iraninezhad H Cureus. 2024; 16(7):e64248.

PMID: 39130853 PMC: 11313744. DOI: 10.7759/cureus.64248.

References

Lorenzo D, Vullierme M, Rebours V . Antitumor Necrosis Factor Therapy Is Effective for Autoimmune Pancreatitis Type 2. Am J Gastroenterol. 2020; 115(7):1133-1134. DOI: 10.14309/ajg.0000000000000668. View

Nista E, De Lucia S, Manilla V, Schepis T, Pellegrino A, Ojetti V . Autoimmune Pancreatitis: From Pathogenesis to Treatment. Int J Mol Sci. 2022; 23(20). PMC: 9604056. DOI: 10.3390/ijms232012667. View

Bateman A, Culver E . Challenges and pitfalls in the diagnosis of IgG4-related disease. Semin Diagn Pathol. 2023; 41(2):45-53. DOI: 10.1053/j.semdp.2023.11.005. View

Sah R, Pannala R, Chari S, Sugumar A, Clain J, Levy M . Prevalence, diagnosis, and profile of autoimmune pancreatitis presenting with features of acute or chronic pancreatitis. Clin Gastroenterol Hepatol. 2009; 8(1):91-6. DOI: 10.1016/j.cgh.2009.09.024. View

de Pretis N, Frulloni L . Autoimmune pancreatitis type 2. Curr Opin Gastroenterol. 2020; 36(5):417-420. DOI: 10.1097/MOG.0000000000000655. View

Sah R, Chari S, Pannala R, Sugumar A, Clain J, Levy M . Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis. Gastroenterology. 2010; 139(1):140-8. DOI: 10.1053/j.gastro.2010.03.054. View

Padureanu V, Florescu D, Padureanu R, Ghenea A, Gheonea D, Oancea C . Role of antioxidants and oxidative stress in the evolution of acute pancreatitis (Review). Exp Ther Med. 2022; 23(3):197. PMC: 8794551. DOI: 10.3892/etm.2022.11120. View

Radulescu P, Caluianu E, Trasca E, Mercut D, Georgescu I, Georgescu E . The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic. Diagnostics (Basel). 2023; 13(14). PMC: 10378087. DOI: 10.3390/diagnostics13142446. View

Agboola A, Mohamed K, Syed M, Shiwlani S, Butt R, Reza R . Type 1 Autoimmune Pancreatitis Masquerading as Pancreatic Head Carcinoma. Cureus. 2023; 15(10):e47471. PMC: 10662655. DOI: 10.7759/cureus.47471. View

10.

Blaho M, Dite P, Kunovsky L, Kianicka B . Autoimmune pancreatitis - An ongoing challenge. Adv Med Sci. 2020; 65(2):403-408. DOI: 10.1016/j.advms.2020.07.002. View

11.

Komar H, Serpa G, Kerscher C, Schwoegl E, Mace T, Jin M . Inhibition of Jak/STAT signaling reduces the activation of pancreatic stellate cells in vitro and limits caerulein-induced chronic pancreatitis in vivo. Sci Rep. 2017; 7(1):1787. PMC: 5431930. DOI: 10.1038/s41598-017-01973-0. View

12.

SARLES H, SARLES J, Muratore R, GUIEN C . Chronic inflammatory sclerosis of the pancreas--an autonomous pancreatic disease?. Am J Dig Dis. 1961; 6:688-98. DOI: 10.1007/BF02232341. View

13.

Naghibi M, Ahmed A, al Badri A, Bateman A, Shepherd H, Gordon J . The successful treatment of IgG4-positive colitis with adalimumab in a patient with IgG4-related sclerosing disease--a new subtype of aggressive colitis?. J Crohns Colitis. 2012; 7(3):e81-4. DOI: 10.1016/j.crohns.2012.05.003. View

14.

Nikolic S, Panic N, Hintikka E, Dani L, Rutkowski W, Hedstrom A . Efficacy and safety of rituximab in autoimmune pancreatitis type 1: our experiences and systematic review of the literature. Scand J Gastroenterol. 2021; 56(11):1355-1362. DOI: 10.1080/00365521.2021.1963837. View

15.

Petzold G, Ellenrieder V, Neesse A . Autoimmune Pancreatitis in Germany: Rare but Relevant. Digestion. 2017; 96(4):185-186. DOI: 10.1159/000481251. View

16.

Radulescu P, Davitoiu D, Baleanu V, Padureanu V, Ramboiu D, Surlin M . Has COVID-19 Modified the Weight of Known Systemic Inflammation Indexes and the New Ones (MCVL and IIC) in the Assessment as Predictive Factors of Complications and Mortality in Acute Pancreatitis?. Diagnostics (Basel). 2022; 12(12). PMC: 9777733. DOI: 10.3390/diagnostics12123118. View

17.

Vinge-Holmquist O, Saltyte Benth J, Arno E, Langbach O, Rokke O . Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period. Scand J Gastroenterol. 2023; 58(12):1534-1541. DOI: 10.1080/00365521.2023.2235452. View

18.

Kawa S . The Immunobiology of Immunoglobulin G4 and Complement Activation Pathways in IgG4-Related Disease. Curr Top Microbiol Immunol. 2016; 401:61-73. DOI: 10.1007/82_2016_39. View

19.

Tacelli M, Celsa C, Magro B, Barresi L, Guastella S, Capurso G . Risk Factors for Rate of Relapse and Effects of Steroid Maintenance Therapy in Patients With Autoimmune Pancreatitis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018; 17(6):1061-1072.e8. DOI: 10.1016/j.cgh.2018.09.051. View

20.

Nikolic S, Lanzillotta M, Panic N, Brismar T, Moro C, Capurso G . Unraveling the relationship between autoimmune pancreatitis type 2 and inflammatory bowel disease: Results from two centers and systematic review of the literature. United European Gastroenterol J. 2022; 10(5):496-506. PMC: 9427095. DOI: 10.1002/ueg2.12237. View