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著者: T Kamisawa, T Shimosegawa, K Okazaki, T Nishino, H Watanabe, A Kanno, F Okumura, T Nishikawa, K Kobayashi, T Ichiya, H Takatori, K Yamakita, K Kubota, H Hamano, K Okamura, K Hirano, T Ito, S B H Ko, M Omata
雑誌名: Gut. 2009 Nov;58(11):1504-7. doi: 10.1136/gut.2008.172908. Epub 2009 Apr 26.
Abstract/Text
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.
PMID 19398440 Gut. 2009 Nov;58(11):1504-7. doi: 10.1136/gut.2008.172908. Epub 2009 Apr 26.
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