Azathioprine shows promise in maintenance treatment of autoimmune pancreatitis

Treatment with azathioprine helps prevent relapse of autoimmune pancreatitis (AIP), according to the results of a systematic review and meta-analysis.

In the study, researchers accessed multiple online databases for studies that evaluated the clinical efficacy of azathioprine as maintenance therapy for AIP patients. They identified 26 studies for qualitative analysis, and 10 of these were included in the meta-analysis.

Ten of the studies were prospective, 12 were retrospective, and four were case reports. Six studies were performed in Asian countries, and 20 in Western countries. The total study population comprised 4,504 patients with AIP/IgG4-related disease (RD) patients.

Of the patients, 3,534 were treated with steroids and 346 received azathioprine for relapsed AIP. Of the 346, at least 187 were type-1 AIP. Across the 13 studies that documented the initial dose of azathioprine, 11 studies used doses for maintenance of 2.0–2.5 mg/kg while two used <2.0 mg/kg.

Pooled data showed that relapse occurred in 14 out of 73 patients (19.2 percent) who received azathioprine for refractory AIP. In contrast, 14 out of 47 patients (29.8 percent) without azathioprine exposure experienced relapse.

Azathioprine was associated with a lower likelihood of relapse (odds ratio, 0.52, 95 percent confidence interval, 0.21–1.27; p=0.15).

The present data support the use of azathioprine as a maintenance treatment in patients with AIP who repeatedly relapse or are resistant to steroids.