title: Standard steroid treatment for autoimmune pancreatitis.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. kamisawa@cick.jp
authors.forename: T
authors.initials: T
authors.lastname: Kamisawa
authors.forename: T
authors.initials: T
authors.lastname: Shimosegawa
authors.forename: K
authors.initials: K
authors.lastname: Okazaki
authors.forename: T
authors.initials: T
authors.lastname: Nishino
authors.forename: H
authors.initials: H
authors.lastname: Watanabe
authors.forename: A
authors.initials: A
authors.lastname: Kanno
authors.forename: F
authors.initials: F
authors.lastname: Okumura
authors.forename: T
authors.initials: T
authors.lastname: Nishikawa
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Ichiya
authors.forename: H
authors.initials: H
authors.lastname: Takatori
authors.forename: K
authors.initials: K
authors.lastname: Yamakita
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: H
authors.initials: H
authors.lastname: Hamano
authors.forename: K
authors.initials: K
authors.lastname: Okamura
authors.forename: K
authors.initials: K
authors.lastname: Hirano
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.forename: S B H
authors.initials: SB
authors.lastname: Ko
authors.forename: M
authors.initials: M
authors.lastname: Omata
mesh_terms: 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
chemical_list: D013256:Steroids; D011239:Prednisolone