Glucocorticoid, cyclophosphamide combo therapy delivers lower relapse in IgG4-RD
Combination therapy of glucocorticoids and cyclophosphamide (CYC) is more effective and has a lower relapse rate than glucocorticoid monotherapy for IgG4 related disease (IgG4-RD), a new study reveals.
The study included 102 IgG4-RD patients randomized to receive either corticosteroid monotherapy (n=52; median age 49.72 years) or in combination with CYC (n=50; median age 53.52 years). Exclusion criteria were serious infections, pregnancy, active hepatitis and serious cardiac insufficiency.
Over a follow-up period of 1 year, relapse rate was significantly higher in the monotherapy group (n=20; 38.5 percent) than in the combination therapy group (n=6; 12.0 percent).
Five patients in the monotherapy group relapsed at 3 months, nine at 6 months and the remaining six at 12 months. In contrast, in the combination therapy group, one patient relapsed at 6 months, and the remaining five at 12 months.
Mean time to flare was significantly greater in the combination therapy group (11.0±2.45 months) than in the monotherapy group (7.05±3.55 months; p=0.018).
In the monotherapy group, 31 patients showed a good response; 13 of which had complete response while 18 had partial response. The 20 patients that relapsed were administered additional immunosuppressive agents which subsequently resulted in a good response.
There were 44 patients who showed no flares in the combination therapy group; 16 of which showed complete response while the remaining 28 had partial response. Of the six patients who relapsed, pancreatitis swelling was observed in one. Methylprednisolone pulse therapy was delivered and improved the organ recurrence.
Rate of disease remission was 59.6 percent (n=31) in the monotherapy group and 88.0 percent (n=44) in the combination therapy group.