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Prognostic factors in IgG4-related disease: a long-term monocentric Chinese cohort study.

Authors :
Zongfei J
Lingying M
Lijuan Z
Ying S
Rongyi C
Dongmei L
Xiufang K
Xiaomin D
Lili M
Huiyong C
Lindi J
Source :
Clinical rheumatology [Clin Rheumatol] 2021 Jun; Vol. 40 (6), pp. 2293-2300. Date of Electronic Publication: 2020 Nov 05.
Publication Year :
2021

Abstract

Objectives: Patients with IgG4-related disease (IgG4-RD) suffer high relapse rates during long-term treatment, but factors that predict relapse outcomes are not well established. In the present study, we aimed to identify predictive factors for treatment resistance and disease relapse in a Chinese IgG4-RD cohort.<br />Methods: This study enrolled 102 patients newly diagnosed with IgG4-RD. Disease prognosis was determined by evaluating disease activity and dosage of glucocorticoids. Predictive factors for refractory and relapsed disease were identified by univariate analysis and Cox regression.<br />Results: Among the 102 patients, 78 cases received medical treatment with regular follow-up (21 [6-111] months). During the follow-up period, 55 (70.5%) patients sustained clinical remission, and 23 (29.5%) patients suffered refractory or relapsed disease. The relapse rate of the patients with IgG4-RD was significantly higher among patients who stopped taking medicine than among those who continued treatment with glucocorticoids (GC) + immunosuppressor (IM). Serum TNF-α ≥ 13 pg/mL, sIL-2R ≥ 1010 U/mL, total cholesterol < 3.55 mmol/L, low-density lipoprotein < 2.0 mmol/L, IgG ≥ 20.2 g/L, and drug withdrawal were predictive factors for refractory and relapsed IgG4-RD. Multivariate Cox regression revealed that both sIL-2R and TNF-α were independent risk factors for refractory and relapsed disease. The combination of GC and IM treatment was an independent protective factor against refractory and relapsed IgG4-RD.<br />Conclusions: High serum levels of sIL-2R and TNF-α may be informative risk factors for refractory and relapsed IgG4-RD. Our data suggest that a combination treatment of GC along with IM may be protective against refractory and relapsed IgG4-RD. Key Points • High sIL-2R and TNF-α levels are informative risk factors for refractory and relapsed IgG4-related disease. • Combination treatment of GC with IM protects against refractory and relapsed IgG4-related disease.

Details

Language :
English
ISSN :
1434-9949
Volume :
40
Issue :
6
Database :
MEDLINE
Journal :
Clinical rheumatology
Publication Type :
Academic Journal
Accession number :
33151477
Full Text :
https://doi.org/10.1007/s10067-020-05484-8