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Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis
Mark Topazian1, Thomas E Witzig, Thomas C Smyrk
1Miles and Shirley Fiterman Center for Digestive Diseases, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55906, USA. topazian.mark@mayo.edu
Background & Aims:
Biliary strictures occur in a third of patients with autoimmune pancreatitis and have been termed immunoglobulin G subclass 4 (IgG4) associated cholangitis (IAC). IAC often responds to steroid therapy.
Methods:
A patient with autoimmune pancreatitis and (IAC) refractory to steroids and 6-mercaptopurine was treated with rituximab, a monoclonal antibody directed against the CD20 antigen on B lymphocytes.
Results:
The patient's biliary strictures improved after rituximab therapy, permitting removal of his biliary stents. Systemic manifestations of IgG4-associated disease also improved.
Conclusions:
Rituximab may be a treatment option for patients with refractory or recurrent autoimmune pancreatitis or IAC.
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