Standard steroid treatment for autoimmune pancreatitis

T. Kamisawa, T. Shimosegawa, K. Okazaki, T. Nishino, H. Watanabe, A. Kanno, F. Okumura, T. Nishikawa, K. Kobayashi, T. Ichiya, H. Takatori, K. Yamakita, K. Kubota, H. Hamano, K. Okamura, K. Hirano, T. Ito, S. B.H. Ko, M. Omata

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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.

Original languageEnglish
Pages (from-to)1504-1507
Number of pages4
JournalGut
Volume58
Issue number11
DOIs
Publication statusPublished - 2009 Nov

ASJC Scopus subject areas

  • Gastroenterology

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    Kamisawa, T., Shimosegawa, T., Okazaki, K., Nishino, T., Watanabe, H., Kanno, A., Okumura, F., Nishikawa, T., Kobayashi, K., Ichiya, T., Takatori, H., Yamakita, K., Kubota, K., Hamano, H., Okamura, K., Hirano, K., Ito, T., Ko, S. B. H., & Omata, M. (2009). Standard steroid treatment for autoimmune pancreatitis. Gut, 58(11), 1504-1507. https://doi.org/10.1136/gut.2008.172908