Pancreas

Standard steroid treatment for autoimmune pancreatitis

T Kamisawa¹, T Shimosegawa², K Okazaki³, T Nishino⁴, H Watanabe⁵, A Kanno², F Okumura⁶, T Nishikawa⁷, K Kobayashi⁸, T Ichiya⁹, H Takatori¹⁰, K Yamakita¹¹, K Kubota¹², H Hamano¹³, K Okamura¹⁴, K Hirano¹⁵, T Ito¹⁶, S B H Ko¹⁷, M Omata¹⁵

¹ Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
² Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
³ Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
⁴ Department of Internal Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Japan
⁵ Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
⁶ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
⁷ Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical College, Asahikawa, Japan
⁸ Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
⁹ Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
¹⁰ Department of Gastroenterology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
¹¹ Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
¹² Division of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
¹³ Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
¹⁴ Department of Gastroenterology, Sapporo Kosei Hospital, Sapporo, Japan
¹⁵ Department of Gastroenterology, University of Tokyo, Tokyo, Japan
¹⁶ Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
¹⁷ Department of Gastroenterology, Nagoya University, Graduate School of Medicine, Nagoya, Japan

^{Correspondence to} Dr T Kamisawa, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan; kamisawa{at}cick.jp

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.

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Rahul Pannala and Suresh T Chari
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• Pannala, R., Chari, S. T (2009). Corticosteroid treatment for autoimmune pancreatitis. Gut 58: 1438-1439 [Full Text]