Standard steroid treatment for autoimmune pancreatitis.
OBJECTIVE
To establish an appropriate steroid treatment regimen for autoimmune pancreatitis (AIP).


METHODS
A retrospective survey of AIP treatment was conducted in 17 centres in Japan. The main outcome measures were rate of remission and relapse.


RESULTS
Of 563 patients with AIP, 459 (82%) received steroid treatment. The remission rate of steroid-treated AIP was 98%, which was significantly higher than that of patients without steroid treatment (74%, 77/104; p<0.001). Steroid treatment was given for obstructive jaundice (60%), abdominal pain (11%), associated extrapancreatic lesions except the biliary duct (11%), and diffuse enlargement of the pancreas (10%). There was no relationship between the period necessary to achieve remission and the initial dose (30 mg/day vs 40 mg/day) of prednisolone. Maintenance steroid treatment was given in 377 (82%) of 459 steroid-treated patients, and steroid treatment was stopped in 104 patients. The relapse rate of patients with AIP on maintenance treatment was 23% (63/273), which was significantly lower than that of patients who stopped maintenance treatment (34%, 35/104; p = 0.048). From the start of steroid treatment, 56% (55/99) relapsed within 1 year and 92% (91/99) relapsed within 3 years. Of the 89 relapsed patients, 83 (93%) received steroid re-treatment, and steroid re-treatment was effective in 97% of them.


CONCLUSIONS
The major indication for steroid treatment in AIP is the presence of symptoms. An initial prednisolone dose of 0.6 mg/kg/day, is recommend, which is then reduced to a maintenance dose over a period of 3-6 months. Maintenance treatment with low-dose steroid reduces but dose not eliminate relapses.
Kamisawa
T
T
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. kamisawa@cick.jp
Shimosegawa
T
T
Okazaki
K
K
Nishino
T
T
Watanabe
H
H
Kanno
A
A
Okumura
F
F
Nishikawa
T
T
Kobayashi
K
K
Ichiya
T
T
Takatori
H
H
Yamakita
K
K
Kubota
K
K
Hamano
H
H
Okamura
K
K
Hirano
K
K
Ito
T
T
Ko
S B H
SB
Omata
M
M
D001327:Autoimmune Diseases / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage*; D012074:Remission Induction; D012189:Retrospective Studies; D055502:Secondary Prevention; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
D013256:Steroids; D011239:Prednisolone