Effectiveness and Safety of Immunosuppressive Therapy in Recurrent Autoimmune Pancreatitis
Abstract
Objective Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis that responds well to glucocorticoid therapy. However, some patients experience frequent relapses or become glucocorticoid-dependent. In Western countries, immunosuppressive agents such as azathioprine are widely used to maintain remission. In contrast, evidence for the use of immunosuppressive agents for AIP is limited in Japan and other Asian countries. Therefore, this study aimed to evaluate the efficacy and safety of immunosuppressive agents in patients with refractory AIP. Methods We retrospectively analyzed 12 Japanese patients with type 1 AIP who experienced two or more documented relapses and received immunosuppressive therapy. Clinical remission, adverse events, and the incidence of malignancy were assessed. Results Among 199 patients with AIP treated between 2006 and 2024, 12 (6.0%) with multiple relapses were administered immunosuppressive agents, including azathioprine (n=9), tacrolimus (n=2), and methotrexate (n=1). Nine patients continued therapy for at least two months; of these, eight (88.9%) maintained clinical remission without relapse during treatment. One patient relapsed. However, three patients (25.0%) were unable to continue therapy due to adverse events. Two patients developed malignancies during the long-term follow-up: one with malignant lymphoma and the other with small cell lung cancer. Conclusion Immunosuppressive therapy may contribute to the maintenance of remission in some AIP patients with glucocorticoid-dependent or repeated relapses, even among Japanese patients. However, adverse events led to treatment discontinuation in 25% of patients, and two developed malignancies during follow-up. These findings underscore the need for careful patient selection, individualized risk-benefit evaluation, and ongoing monitoring.
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BibTeX
@article{kurita2026effectiveness,
title = {{Effectiveness and Safety of Immunosuppressive Therapy in Recurrent Autoimmune Pancreatitis}},
author = {Yusuke Kurita and Kensuke Kubota and Ryusuke Yoshimi and Yuji Fujita and Emiko Tanida and Yu Honda and Takeshi Iizuka and Shin Yagi and Sho Hasegawa and Noritoshi Kobayashi and Masato Yoneda},
journal = {Internal Medicine},
year = {2026},
month = oct,
doi = {10.2169/internalmedicine.6646-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_6646-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Effectiveness and Safety of Immunosuppressive Therapy in Recurrent Autoimmune Pancreatitis
AU - Yusuke Kurita
AU - Kensuke Kubota
AU - Ryusuke Yoshimi
AU - Yuji Fujita
AU - Emiko Tanida
AU - Yu Honda
AU - Takeshi Iizuka
AU - Shin Yagi
AU - Sho Hasegawa
AU - Noritoshi Kobayashi
AU - Masato Yoneda
PY - 2026
DA - 2026/10/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.6646-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_6646-25/_article
AB - Objective Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis that responds well to glucocorticoid therapy. However, some patients experience frequent relapses or become glucocorticoid-dependent. In Western countries, immunosuppressive agents such as azathioprine are widely used to maintain remission. In contrast, evidence for the use of immunosuppressive agents for AIP is limited in Japan and other Asian countries. Therefore, this study aimed to evaluate the efficacy and safety of immunosuppressive agents in patients with refractory AIP. Methods We retrospectively analyzed 12 Japanese patients with type 1 AIP who experienced two or more documented relapses and received immunosuppressive therapy. Clinical remission, adverse events, and the incidence of malignancy were assessed. Results Among 199 patients with AIP treated between 2006 and 2024, 12 (6.0%) with multiple relapses were administered immunosuppressive agents, including azathioprine (n=9), tacrolimus (n=2), and methotrexate (n=1). Nine patients continued therapy for at least two months; of these, eight (88.9%) maintained clinical remission without relapse during treatment. One patient relapsed. However, three patients (25.0%) were unable to continue therapy due to adverse events. Two patients developed malignancies during the long-term follow-up: one with malignant lymphoma and the other with small cell lung cancer. Conclusion Immunosuppressive therapy may contribute to the maintenance of remission in some AIP patients with glucocorticoid-dependent or repeated relapses, even among Japanese patients. However, adverse events led to treatment discontinuation in 25% of patients, and two developed malignancies during follow-up. These findings underscore the need for careful patient selection, individualized risk-benefit evaluation, and ongoing monitoring.
SN - 1349-7235
SN - 0918-2918
ER -