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Standard steroid therapy for autoimmune pancreatitis
  1. Terumi Kamisawa (kamisawa{at}cick.jp)
  1. Tokyo Metropolitan Komagome Hospital, Japan
    1. Tooru Shimosegawa (tshimosegawa{at}int3.med.tohoku.ac.jp)
    1. Tohoku University Graduate School of Medicine, Japan
      1. Kazuichi Okazaki (okazaki{at}takii.kmu.ac.jp)
      1. Kansai Medical University, Japan
        1. Takayoshi Nishino (tnishino{at}tymc.twmu.ac.jp)
        1. Tokyo Women's Medical University Yachiyo Medical Center, Japan
          1. Hiroyuki Watanabe (watahiro{at}kenroku.kanazawa-u.ac.jp)
          1. Cancer Research Institute, Kanazawa University, Japan
            1. Atsushi Kanno (atsushih{at}cocoa.ocn.ne.jp)
            1. Tohoku University Graduate School of Medicine, Japan
              1. Fumihiro Okumura (fokumura{at}med.nagoya-cu.ac.jp)
              1. Nagoya City University Graduate School of Medical Sciences, Japan
                1. Tomoya Nishikawa (nishikaw{at}asahikawa-med.ac.jp)
                1. Asahikawa Medical College, Japan
                  1. Kenso Kobayashi (kenso{at}hiroshima-u.ac.jp)
                  1. Hiroshima University, Japan
                    1. Tamaki Ichiya (tamaki_ichiya{at}yahoo.co.jp)
                    1. Teine-Keijinkai Hospital, Japan
                      1. Hajime Takatori (takatori{at}m-kanazawa.jp)
                      1. Kanazawa University Graduate School of Medical Science, Japan
                        1. Keisuke Yamakita (y_consent{at}hotmail.com)
                        1. Aichi Cancer Center Hospital, Japan
                          1. Kensuke Kubota (kubotak{at}yokohama-cu.ac.jp)
                          1. Yokohama City Hospital, Japan
                            1. Hideaki Hamano (hidehama{at}h3.dion.ne.jp)
                            1. Shinshu University School of Medicine, Japan
                              1. Keiya Okamura (ke-ya{at}nifty.com)
                              1. Sapporo Kosei Hospital, Japan
                                1. Kenji Hirano (khirano-tky{at}umin.ac.jp)
                                1. Tokyo University, Japan
                                  1. Tetsuhide Ito (itopapa{at}intmed3.med.kyushu-u.ac.jp)
                                  1. Kyushu University, Japan
                                    1. SBH Ko (sko{at}med.nagoya-u.ac.jp)
                                    1. Nagoya University, Japan
                                      1. Masao Omata (omata-2im{at}h.u-tokyo.ac.jp)
                                      1. Tokyo University, Japan

                                        Abstract

                                        Objective: To establish appropriate steroid therapy regimen for autoimmune pancreatitis (AIP).

                                        Design, setting and participants: Retrospective survey of AIP treatment was conducted in 17 centers in Japan.

                                        Interventions: Steroid therapy.

                                        Main outcome measures: Rate of remission and relapse.

                                        Results: Of 563 AIP patients, 459 (82%) received steroid therapy. Remission rate of steroid-treated AIP was 98%, which was significantly higher than that of patients without steroid therapy (74%, 77/104; p<0.001). Steroid therapy 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 therapy was performed in 377 (82%) of 459 steroid-treated patients, and steroid therapy was stopped in 104 patients. The relapse rate of AIP patients on maintenance therapy was 23% (63/273), which was significantly lower than that of patients who stopped maintenance therapy (34%, 35/104; p=0.048). From the start of steroid therapy, 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 therapy in AIP is the presence of symptoms. We recommend an initial prednisolone dose of 0.6 mg/kg/day, which is then reduced to a maintenance dose over a period of 3-6 months. Maintenance therapy with low-dose steroid reduces but dose not eliminate relapses.

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