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. (25th May 2022)

• Record Type: Journal Article
• Authors: Kubota, Kensuke; Kamisawa, Terumi; Nakazawa, Takahiro; Tanaka, Atsushi; Naitoh, Itaru; Takikawa, Hajime; Unno, Michiaki; Kawa, Shigeyuki; Masamune, Atsushi; Nakamura, Seiji; Okazaki, Kazuichi
• Other Names: Furumatsu Keisuke investigator.; Sawai Shigeaki investigator.; Goto Takuma investigator.; Okumura Toshikatsu investigator.; Suzuki Daisuke investigator.; Otsuka Masayuki investigator.; Kobori Ikuhiro investigator.; Tamano Masaya investigator.; Koizumi Mitsuhito investigator.; Hiasa Yoichi investigator.; Kawabe Naoto investigator.; Hirooka Yoshiki investigator.; Yamamoto Satoshi investigator.; Asano Yukio investigator.; Inui Kazuo investigator.; Horiguchi Akihiko investigator.; Watanabe Hiroyuki investigator.; Toya Daishu investigator.; Hatayama Katsuko investigator.; Ueki Toshiharu investigator.; Kinoshita Norikatsu investigator.; Sugimoto Mitsuru investigator.; Ohira Hiromasa investigator.; Mukai Tsuyoshi investigator.; Tomita Eiichi investigator.; Iwata Keisuke investigator.; Shimizu Shogo investigator.; Suetsugu Jun investigator.; Shimizu Masahito investigator.; Tsuji Keiji investigator.; Ishida Ryoko investigator.; Ito Masanori investigator.; Furukawa Ryutaro investigator.; Sakamoto Naoya investigator.; Araki Masahiro investigator.; Tanno Satoshi investigator.; Sakamoto Yasunari investigator.; Ito Tetsuhide investigator.; Takai Satoshi investigator.; Ikeya Shinichi investigator.; Yamada Takanori investigator.; Kudara Norihiko investigator.; Shimizu Akinori investigator.; Hanada Keiji investigator.; Ichiki Yasunori investigator.; Kitada Hideki investigator.; Hifumi Michio investigator.; Kimura Hiroyuki investigator.; Kurosaki Masayuki investigator.; Izumi Namiki investigator.; Sumi Hajime investigator.; Haruta investigator.; Hayashi Katsumi investigator.; Harada Ryo investigator.; Inoue Masafumi investigator.; Nakamura Shinichiro investigator.; Ito Tetsuya investigator.; Tomishima Ko investigator.; Isayama Hiroyuki investigator.; Oura Kyoko investigator.; Masaki Tsutomu investigator.; Shimokawahara Naoto investigator.; Tanoue Shirou investigator.; Maemura Kousei investigator.; Ido Akio investigator.; Mizushima Ichiro investigator.; Kawano Mitsuhiro investigator.; Yoshida Katsunori investigator.; Naganuma Makoto investigator.; Murata Miki investigator.; Nishio Akiyoshi investigator.; Fujita Yuji investigator.; Teratani Takuma investigator.; Matsubara Shohei investigator.; Tamai Hironao investigator.; Yoshida Yuu investigator.; Azemoto Ryousaku investigator.; Kamata Ken investigator.; Watanabe Tomohiro investigator.; Kurosu Takahiro investigator.; Koizumi Wasaburou investigator.; Fujita Jun investigator.; Seki Hideyuki investigator.; Ueda Yasuhiro investigator.; Fukumoto Takumi investigator.; Kousaki Takuhiro investigator.; Uchida Kazushige investigator.; Ochiai Toshimasa investigator.; Kawasaki Takeshi investigator.; Tanaka Motohiko investigator.; Ishida Etsuji investigator.; Notohara Kenji investigator.; Mori Hideaki investigator.; Mori Toshiyuki investigator.; Kawabata Hideaki investigator.; Miyata Masatoshi investigator.; Sakagami Junichi investigator.; Itoh Yoshito investigator.; Shiokawa Masahiro investigator.; Seno Hiroshi investigator.; Watanabe Noriko investigator.; Naitoh Itaru investigator.; Kataoka Hiromi investigator.; Aoki Toshinori investigator.; Fujishiro Mitsuhiro investigator.; Niihara Toru investigator.; Nishimata Hiroto investigator.; Mitoro Akira investigator.; Yoshiji Hitoshi investigator.; Yoshida Motoyuki investigator.; Ikeda Masafumi investigator.; Tomita Kengo investigator.; Hokari Ryota investigator.; Hayasaka Kenji investigator.; Amano Yuji investigator.; Shioji Kazuhiko investigator.; Hayashi Kazunao investigator.; Terai Shuji investigator.; Nakajima Michiko investigator.; Yamahana Junya investigator.; Matsumoto Ryusuke investigator.; Kikuchi Hideaki investigator.; Kanamori Akira investigator.; Kiriyama Seiki investigator.; Iwatsu Shinichi investigator.; Kato Yuji investigator.; Horiguchi Shigeru investigator.; Yagi Takahito investigator.; Okada Hiroyuki investigator.; Ohkawa Kazuyoshi investigator.; Hirao Motohiro investigator.; Hiramatsu Naoki investigator.; Oza Noriko investigator.; Imamura Haruo investigator.; Baba Takeshi investigator.; Nakano Shigeru investigator.; Shinobi Tetsuya investigator.; Ryozawa Shomei investigator.; Motoya Masayo investigator.; Nakase Hiroshi investigator.; Kinoshita Noboru investigator.; Ito Kei investigator.; Miyake Tatsuya investigator.; Kohge Naruaki investigator.; Tobita Hiroshi investigator.; Joshita Satoru investigator.; Umemura Takeji investigator.; Kawaguchi Shinya investigator.; Ohno Kazuya investigator.; Sonobe Koichi investigator.; Satoh Akihiko investigator.; Shimosegawa Tooru investigator.; Miura Fumihiko investigator.; Yagi Minami investigator.; Sano Keiji investigator.; Kin Toshifumi investigator.; Katanuma Akio investigator.; Koike Kazuhiko investigator.; Miura Shin investigator.; Kawashima Youhei investigator.; Kagawa Tatehiro investigator.; Azuma Seishin investigator.; Watanabe Mamoru investigator.; Honjyo Mitsuyoshi investigator.; Itoi Takao investigator.; Honda Akira investigator.; Kobayashi Katsumasa investigator.; Asano Toru investigator.; Mizuno Suguru investigator.; Koike Kazuhiko investigator.; Nishino Takayoshi investigator.; Taniguchi Hideaki investigator.; Tajiri Kazuto investigator.; Yasuda Ichiro investigator.; Tanaka Yoshiya investigator.; Oe Shinji investigator.; Harada Masaru investigator.; Kurata Masanao investigator.; Fukasawa Mituharu investigator.; Enomoto Nobuyuki investigator.; Kawaji Yuki investigator.; Kitano Masayuki investigator.; Nishise Yuko investigator.; Hirakawa Hidetoshi investigator.; Ishizawa Tetsuya investigator.; Ueno Yoshiyuki investigator.; Kaino Miyuki investigator.; Fujimoto Yuko investigator.; Sakaida Isao investigator.;
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 29:Number 8(2022)
• Page Start: 884
• Page End: 897
• Publication Date: 2022-05-25
• Subjects: IgG4‐related sclerosing cholangitis -- relapse -- steroid -- steroid related complications, limitation of steroid; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.1157
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: 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 in 99.5% (763/767) of patients who received steroid therapy, while the remission rate dropped to 63.6% (78/129) of patients who did not 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 levels were achieved at 2 weeks regardless of biliary drainage. Multivariate analysis identified younger onset, MST less than 3 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 <3 years to reduce the risk of relapse, with use of preemptive measures taken around 5 years. The biliary drainage might not be mandatory. Steroid as 1st line therapy could serve as a bridge to further promising treatments. Abstract : The acceptable duration of steroid therapy for IgG4‐sclerosing cholangitis remains debated. Kubota et al conclude that steroid therapy should be continued at least 3 years to reduce the risk of relapse, with preemptive measures taken around 5 years. Steroids as first‐line therapy could serve as a bridge to further promising treatments.