Development of an algorithm for IgG4-related disease management.

Autor: Orozco-Gálvez O; Division of Systemic Autoimmune Diseases, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Fernández-Codina A; Division of Systemic Autoimmune Diseases, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Divisions of Rheumatology (London and Windsor campuses) and General Internal Medicine (Windsor Campus), Western University, London, Ontario, Canada., Lanzillotta M; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, UNIRAR, IRCCS Ospedale San Raffaele, Milan, Italy., Ebbo M; Internal Medicine Department, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France., Schleinitz N; Internal Medicine Department, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France., Culver EL; Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; University of Oxford, Oxford, United Kingdom., Rebours V; Pancreatology Department, Beaujon Hospital, Clichy, Université de Paris, France., D'Cruz DP; Rheumatology Department, Louise Coote Lupus Unit, Guy's Hospital, London, United Kingdom., Della-Torre E; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, UNIRAR, IRCCS Ospedale San Raffaele, Milan, Italy., Martínez-Valle F; Division of Systemic Autoimmune Diseases, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: Fernando.martinez@vallhebron.cat.
Jazyk: angličtina
Zdroj: Autoimmunity reviews [Autoimmun Rev] 2023 Mar; Vol. 22 (3), pp. 103273. Date of Electronic Publication: 2023 Jan 20.
DOI: 10.1016/j.autrev.2023.103273
Abstrakt: Objectives: IgG4-related disease (IgG4-RD) is a rare fibro-inflammatory condition affecting multiple organs lacking standardized management. In this article, we review the evidence available to provide European expert-based statements on the management of IgG4-RD which were integrated in a final algorithm.
Methods: A panel of nine European experts in IgG4-RD from different specialties was asked to elaborate a set of consensus statements through a Delphi exercise. Three rounds of survey were taken. Consensus was reached when ≥75% of the responders agreed with a statement.
Results: Thirty-one statements on induction treatment, maintenance treatment, non-pharmacological treatment, and general considerations were assessed. Patients should be treated promptly in situations when there is an immediate organ threatened, or when organ damage is anticipated. Glucocorticoids (GC) are considered the first line of treatment and should be progressively tapered. Maintenance treatment is recommended for patients with high disease activity or with risk factors for relapse. Rituximab is effective for induction and maintenance of remission, but its use can be limited by economics. Low dose GC with or without GC-sparing agents can be used for maintenance therapy. Stenting or surgery should be ancillary to pharmacological treatment. Follow up should be based on physical examination, blood works, and imaging studies. Furthermore, it should be tailored on individual patient clinical history. 18-fluorodeoxyglucose positron emission tomography/computerized tomography may provide additional information over other imaging modalities.
Conclusions: These new statements and algorithm reached a high degree of agreement and may help guiding the clinical management of IgG4-RD.
Competing Interests: Declaration of Competing Interest Fernando Martínez-Valle received research grants from Viela Bio (Horizon Therapeutics) and honoraria from Medpace. Emma L. Culver received research support from the National Institute Health Research (NIHR) Oxford Biomedical Research Centre (BRC). None of the other authors has competing interests for this manuscript.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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