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.
journal_name
Gutjournal_title
Gutauthors
Kamisawa T,Shimosegawa T,Okazaki K,Nishino T,Watanabe H,Kanno A,Okumura F,Nishikawa T,Kobayashi K,Ichiya T,Takatori H,Yamakita K,Kubota K,Hamano H,Okamura K,Hirano K,Ito T,Ko SB,Omata Mdoi
10.1136/gut.2008.172908subject
Has Abstractpub_date
2009-11-01 00:00:00pages
1504-7issue
11eissn
0017-5749issn
1468-3288pii
gut.2008.172908journal_volume
58pub_type
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