Document Detail


Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis.
MedLine Citation:
PMID:  22611324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systemic corticosteroids represent the standard treatment for autoimmune pancreatitis with IgG4-associated cholangitis. For steroid-dependent disease, azathioprine has been used for maintenance of remission. Mycophenolate mofetil has been used for transplant immunosuppression and more recently for autoimmune hepatitis; however, there are no case reports to date on the use of mycophenolate mofetil in adult patients with autoimmune pancreatitis. A patient with IgG4-mediated autoimmune pancreatitis and IgG4-associated cholangitis refractory to steroids and intolerant of azathioprine was treated with mycophenolate mofetil, which inhibits de novo guanosine synthesis and blockade of both B and T lymphocyte production. Introduction of mycophenolate mofetil and uptitration to 1000 mg by mouth twice daily over a treatment period of 4 mo was associated with improvement in the patient's energy level and blood glucose control and was not associated with any adverse events. The patient was managed without a biliary stent. However, there was a return of symptoms, jaundice, increase in transaminases, and hyperbilirubinemia when the prednisone dose reached 11 mg per day. In the first report of mycophenolate mofetil use in an adult patient with IgG4-associated autoimmune pancreatitis and IgG4-associated cholangitis, the introduction of mycophenolate mofetil was safe and well-tolerated without adverse events, but it did not enable discontinuation of the steroids. Mycophenolate mofetil and other immunomodulatory therapies should continue to be studied for maintenance of remission in the large subset of patients with refractory or recurrent autoimmune pancreatitis.
Authors:
Jamie B Sodikoff; Steven A Keilin; Qiang Cai; Sheila J Bharmal; Melinda M Lewis; Gottumukkala S Raju; Field F Willingham
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  18     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-21     Completed Date:  2012-09-17     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  2287-90     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Aged
Autoimmune Diseases / blood,  diagnosis,  drug therapy*,  immunology
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis / blood,  diagnosis,  drug therapy*,  immunology
Drug Therapy, Combination
Humans
Immunoglobulin G / blood*
Immunosuppressive Agents / therapeutic use*
Male
Mycophenolic Acid / analogs & derivatives*,  therapeutic use
Pancreatitis / blood,  diagnosis,  drug therapy*,  immunology
Recurrence
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Immunoglobulin G; 0/Immunosuppressive Agents; 9242ECW6R0/mycophenolate mofetil; HU9DX48N0T/Mycophenolic Acid
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