title: Outcome of Long-term Maintenance Steroid Therapy Cessation in Patients With Autoimmune Pancreatitis: A Prospective Study.
abstract: OBJECTIVE
  To predict the duration of steroid maintenance therapy required to achieve good prognosis in patients with autoimmune pancreatitis.
  
  
  METHODS
  The study sample comprised 21 patients with autoimmune pancreatitis who met the following criteria: (1) they received steroid therapy (ST) for at least 3 years without clinical relapse; and (2) immunoglobulin (Ig) G<1600 mg/dL was observed in the past year with a prednisolone maintenance dose ≤5 mg. All patients could be diagnosed with international consensus diagnostic criteria. Patients were prospectively followed up after tapering and cessation of steroids. Clinical relapse was defined as the need to resume ST. Serological relapse was defined as having an IgG level of >1600 mg/dL.
  
  
  RESULTS
  During the 43-month (range, 19 to 48 mo) follow-up period, clinical relapse occurred in 10 patients: pancreatic lesion in 4; coronary lesion in 2; submandibular lesion in 1; both pulmonary and renal lesions in 1; pulmonary, retroperitoneal, and submandibular lesions in 1; and bronchial asthma in 1. Serological relapse was observed in 12 patients. Although clinical and serological relapse occurred concomitantly in 3 patients, serological relapse preceded clinical relapse in 4 patients. Five patients experienced serological relapse alone, and no clinical or serological relapse occurred in 6 patients. According to Cox proportional hazard analysis, the duration of ST before tapering was a significant predictive parameter (hazard ratio, 0.969/month; 95% confidence interval, 0.940-0.998; P=0.038).
  
  
  CONCLUSIONS
  ST cessation resulted in a high rate of clinical relapses, even in patients with long-term maintenance therapy. Therefore, it appears desirable to continue steroid maintenance therapy for a period >3 years to prevent relapse.
authors.affiliation: *Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku†Department of Gastroenterology, Tokyo Takanawa Hospital, Takanawa Minato-ku‡Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Gyotane
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authors.lastname: Umefune
authors.forename: Dai
authors.initials: D
authors.lastname: Akiyama
authors.forename: Takeo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Saito
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takagi
authors.forename: Naminatsu
authors.initials: N
authors.lastname: Takahara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Koji
authors.initials: K
authors.lastname: Miyabayashi
authors.forename: Dai
authors.initials: D
authors.lastname: Mohri
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D013256:Steroids