title: Correlation between long-term outcome and steroid therapy in type 1 autoimmune pancreatitis: relapse, malignancy and side effect of steroid.
abstract: OBJECTIVE
  Autoimmune pancreatitis (AIP) responds well to corticosteroid therapy (CST), and CST is essential to induce remission. However, the correlation between long-term outcome and CST has not been evaluated. We aimed to clarify the correlation between long-term outcome of AIP and CST.
  
  
  METHODS
  We retrospectively evaluated relapse, risk of malignancy and side effects of CST by focusing on the correlation with CST in 84 patients with type 1 AIP.
  
  
  RESULTS
  The incidence of relapse was 23.8%. The frequency of relapse after CST administration was significantly lower in patients taking CST for >6 months than in those who did not (22% versus 67%; p = 0.036). The incidence of malignancy was 10.7%. The standardized incidence ratio of malignancy was 2.14 [95% confidence interval 0.74-3.54]. There were no significant correlations between development of malignancy and CST. The incidences of total and serious side effects due to CST were 75% and 19.1%, respectively. Relapse was the only significant independent predictive risk factor for serious side effects in a multivariate analysis (odds ratio 4.065; 95% confidence interval 1.125-14.706; p = 0.032). The cumulative dose of corticosteroid was significantly higher in patients with serious side effects than in those without (12,645 mg versus 7322 mg; p = 0.041).
  
  
  CONCLUSIONS
  CST reduces relapse of AIP. However, CST causes serious side effects, particularly in relapsing patients. Alternative maintenance therapy to prevent relapse is needed.
authors.affiliation: Department of Gastroenterology and Metabolism , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takada
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D010195:Pancreatitis / Q000145:classification / Q000188:drug therapy*; D012372:ROC Curve; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G
keywords: Relapse; risk of malignancy; side effect of steroid therapy; type 1 autoimmune pancreatitis