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Clinicoserological factors associated with response to steroid treatment and recurrence in patients with IgG4-related ophthalmic disease
  1. Ji Wook Hong,
  2. Sunah Kang,
  3. Min Kyung Song,
  4. Chan Joo Ahn,
  5. Ho-Seok Sa
  1. Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
  1. Correspondence to Dr Ho-Seok Sa, Department of Ophthalmology, University of Ulsan, Songpa-gu, Seoul 05505, Korea; lineblue{at}hanmail.net

Abstract

Purpose To investigate the factors associated with response to steroid treatment and recurrence in patients with IgG4-related ophthalmic disease (ROD).

Methods Twenty-eight patients with biopsy-proven IgG4-ROD treated between March 2010 and January 2017 were included in this retrospective study. Clinical features, serum IgG4 levels, systemic involvement, treatments and treatment outcome, factors associated with response to treatment and recurrence were assessed.

Result Thirteen men and 15 women (mean age 50.8 years) were evaluated over mean follow-up period of 27.3 months. Elevated serum IgG4 levels (>1.35 g/L) and systemic disease were noted in 9 (32%) and 18 patients (64%), respectively. The lacrimal gland was involved in all patients, and 22 patients (78.6%) had bilateral involvement. Most patients (82%) responded well to systemic steroids, but 12 (43%) relapsed after the initial steroid treatment, requiring additional therapies to achieve remission. Complete response to initial steroid treatment was associated with elevated serum IgG4 levels before treatment (P=0.001) and bilateral orbital involvement (P=0.050). Recurrence was associated with elevated serum IgG4 levels before treatment (P=0.007), lower dose (P=0.057) and shorter duration of initial steroids (P=0.042). Patients with recurrence eventually required significantly more steroids than those without recurrence (P=0.011).

Conclusions Patients with IgG4-ROD responded well to systemic steroid treatment, but recurrence was common, particularly among those with elevated serum IgG4 levels and shorter duration of initial steroid treatment. Low-dose maintenance treatment with systemic steroids should be considered to avoid recurrence in patients with elevated serum IgG4 levels.

  • orbital IgG4-related disease
  • serum IgG4 level
  • systemic steroid treatment

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Footnotes

  • Contributors All authors take responsibility for the integrity of the data and the accuracy of the data analysis. JWH: analysis and interpretation of data, writing the article, proof and revising the article. SK: design of the study, acquisition and analysis of data. MKS, CJA: analysis and interpretation of data. H-SS: design of the study, analysis and interpretation of data, proof and revising the article.

  • Disclaimer The authors have no proprietary interests in or financial support for the development or marketing of instruments or equipment mentioned in this article or any competing instruments or equipment.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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