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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

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.

https://doi.org/10.1136/gut.2008.172908

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    Footnotes

    • Competing interests None.

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

    • See Commentary, p 1438

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