Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Kiel, Germany.
Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany.
Front Immunol. 2023 Jun 19;14:1201363. doi: 10.3389/fimmu.2023.1201363. eCollection 2023.
Autoimmune pancreatitis responds well to corticosteroids in most instances. Additional immunosuppression or low-dose maintenance steroids may be necessary upon relapse. There is limited data on alternative strategies when these regiments fail or cause adverse reactions. We report a case of a middle-aged woman with autoimmune pancreatitis in whom tapering of prednisolone below the dose of 25mg per day resulted in relapse of symptoms and long-term steroid use led to development of steroid induced hyperglycaemia. Induction and maintenance of steroid-free remission was ultimately successful under vedolizumab therapy. Remission has been stable for over one year with reduced need for antidiabetic intervention. This is the first reported case of treatment of refractory autoimmune pancreatitis with vedolizumab. It highlights the overlap of immunological mechanisms within inflammatory diseases of the digestive tract and how knowledge of biological data can inform treatment decisions for individual cases. The demonstrated efficacy of vedolizumab and low risk of severe side effects warrant further investigation into its use in autoimmune pancreatitis.
自身免疫性胰腺炎在大多数情况下对皮质类固醇反应良好。在复发时,可能需要额外的免疫抑制或低剂量维持类固醇。当这些方案失败或引起不良反应时,替代策略的数据有限。我们报告了一例中年女性自身免疫性胰腺炎患者,其泼尼松龙剂量降至每天 25mg 以下导致症状复发,长期使用类固醇导致类固醇诱导性高血糖。最终,在维多珠单抗治疗下成功诱导并维持无类固醇缓解。缓解已经稳定了一年多,减少了对糖尿病治疗的需求。这是首例报道的用维多珠单抗治疗难治性自身免疫性胰腺炎的病例。它强调了消化道炎症性疾病中免疫机制的重叠,以及对生物数据的了解如何为个别病例的治疗决策提供信息。维多珠单抗的疗效已得到证实,且严重副作用的风险低,因此有必要进一步研究其在自身免疫性胰腺炎中的应用。