rss
Gut 2009;58:1504-1507 doi:10.1136/gut.2008.172908
  • Pancreas

Standard steroid treatment for autoimmune pancreatitis

  1. T Kamisawa1,
  2. T Shimosegawa2,
  3. K Okazaki3,
  4. T Nishino4,
  5. H Watanabe5,
  6. A Kanno2,
  7. F Okumura6,
  8. T Nishikawa7,
  9. K Kobayashi8,
  10. T Ichiya9,
  11. H Takatori10,
  12. K Yamakita11,
  13. K Kubota12,
  14. H Hamano13,
  15. K Okamura14,
  16. K Hirano15,
  17. T Ito16,
  18. S B H Ko17,
  19. M Omata15
  1. 1
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
  2. 2
    Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
  3. 3
    Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
  4. 4
    Department of Internal Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Japan
  5. 5
    Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
  6. 6
    Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  7. 7
    Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical College, Asahikawa, Japan
  8. 8
    Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
  9. 9
    Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
  10. 10
    Department of Gastroenterology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  11. 11
    Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
  12. 12
    Division of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
  13. 13
    Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
  14. 14
    Department of Gastroenterology, Sapporo Kosei Hospital, Sapporo, Japan
  15. 15
    Department of Gastroenterology, University of Tokyo, Tokyo, Japan
  16. 16
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  17. 17
    Department of Gastroenterology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  1. 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
  • Revised 22 February 2009
  • Accepted 17 March 2009
  • Published Online First 26 April 2009

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.

Footnotes

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • See Commentary, p 1438

This Article

  1. Abstract
  2. Full text
  3. PDF
  4. All Versions of this Article:
    1. gut.2008.172908v1
    2. 58/11/1504 most recent

Social bookmarking

Latest from Gut Education

Latest from Gut Education

Register for free content


Free sample
 This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of Gut.
View free sample issue >>

Free archive
The full back archive is now available for Gut. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006, back to volume 1 issue 1.
Register to access the free archive >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.