Correlation between long-term outcome and steroid therapy in type 1 autoimmune pancreatitis: relapse, malignancy and side effect of steroid

Abstract

CST reduces relapse of AIP. However, CST causes serious side effects, particularly in relapsing patients. Alternative maintenance therapy to prevent relapse is needed.

Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis

“…To our knowledge, this is the first randomised controlled trial of corticosteroid therapy in patients with AIP. Although it was suggested by retrospective studies,8 9 16 21 our results showed that maintenance therapy until 3 years might be useful for the prevention of relapses in patients with AIP.…”

“…The cumulative amount of PSL administered during the 3-year maintenance therapy at 5 mg/day of PSL is well below the cut-off value of 8694 mg/dL. The cumulative amount of PSL >10 000 mg, which corresponds approximately to a 5-year maintenance therapy,21 was a significant risk factor for the development of serious side effects. Importantly, the cumulative amounts of corticosteroid are increased in patients with relapses, because the relapsed cases are treated with readministration or dose up of PSL.…”

“…Importantly, the cumulative amounts of corticosteroid are increased in patients with relapses, because the relapsed cases are treated with readministration or dose up of PSL. Relapse was a significant independent predictive risk factor for serious corticosteroid-related complications in patients with AIP 21. Some reports have suggested that maintenance therapy longer than 3 years is required to prevent relapses 21 26.…”

“…There are few studies dealing with the threshold of serious corticosteroid-related complications in patients with AIP. Shimizu et al 21 reported that the cumulative amount of corticosteroid was significantly higher in patients with serious side effects than in those without (12 645 vs 7322 mg; p=0.041). In the receiver operating characteristic curve analysis, the best cut-off value of cumulative corticosteroid for serious complications was 8694 mg/dL with moderate diagnostic accuracy determined using an area under the curve of 0.711.…”

“…Relapse was a significant independent predictive risk factor for serious corticosteroid-related complications in patients with AIP 21. Some reports have suggested that maintenance therapy longer than 3 years is required to prevent relapses 21 26. Obviously, the risks of corticosteroid-related complications and of disease relapses should be estimated carefully in each AIP case.…”