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Autoimmune pancreatitis (AIP) is a fibro-inflammatory disease, which has defining histopathology and is characterised by a dramatic response to steroid treatment.1 Type 1 AIP describes the pancreatic manifestation of a multiorgan syndrome, currently referred to as IgG4-related disease and is frequently associated with an elevated serum IgG4 antibody level.2 This is a chronic disease with relapses occurring in 30–50% of patients within 3 years of disease onset.3 ,4 Published data suggest that low-dose maintenance steroids may decrease the risk for future disease relapse; however, this has not been demonstrated in a prospective clinical trial.5 In the present study, Masamune et al6 present their findings from a randomised controlled trial (RCT) examining the efficacy of low-dose steroids for maintenance of disease remission. We discuss this article in the context of the existing literature and identify future opportunities to improve the management of type 1 AIP.
In the present study, the authors present their findings from a multicenter, double-blind RCT using low-dose steroids for maintenance of disease remission. A total of 49 subjects were enrolled with a diagnosis of AIP based on the Japanese Pancreas Society diagnostic criteria, with all but two also meeting the International Consensus Diagnostic Criteria for AIP. Treatment naive subjects were randomised at the time of diagnosis to one of two strategies for maintenance therapy. Both groups received similar treatment over the initial 26 weeks, which consisted of high-dose steroids (prednisolone 0.6 mg/kg/day) with a taper over 12 weeks, then intermediate-term exposure to a low steroid dose (prednisolone 5–7.5 mg/day) over the next 14 weeks. At the end of 26 weeks, subjects randomised to the maintenance therapy arm continued their low steroid dose for the remainder of the 3 year study period, whereas those in the steroid cessation arm discontinued steroid use.