首页|Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis

Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis

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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.

Autoimmune diseasesPancreatitisMycophenolate mofetilRecurrence

Jamie B Sodikoff、Steven A Keilin、Qiang cai、Sheila J Bharmal、Melinda M Lewis、Gottumukkala S Raju、Field F Willingham

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Division of Digestive Diseases,Department of Medicine, Emory University School of Medicine,Atlanta, GA 30322, United States

Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, United States

Department of Gastroenterology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States

2012

10.3748/wjg.v18.i18.2287

世界胃肠病学杂志(英文版)
太原消化病研治中心

世界胃肠病学杂志(英文版)

SCI
影响因子：1.001
ISSN：1007-9327
年,卷(期)：2012.18(18)
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