Treatment and Relapse of Autoimmune Pancreatitis

Abstract

Autoimmune pancreatitis (AIP) is a peculiar type of chronic pancreatitis whose pathogenesis involves autoimmune mechanisms. The steroid responsiveness has a significant impact on the diagnosis of AIP because patients with AIP and pancreatic cancer share many clinical features. This review focuses on the treatment and relapse of AIP. The goal of AIP treatment is remission of symptoms, serology, radiologic changes, or histology, which also applies to relapse. Although it is generally agreed that steroids should be offered to AIP patients with active disease, there is no standardized steroid regimen for AIP and no consensus on the dose and duration of steroid induction and tapering schedule, and optimal duration and dose of maintenance therapy. Obtaining a consensus on the optimal treatment regimen is very important to reducing the relapse rate. In this review, we discuss the treatment regimens used in many centers. (Gut and Liver 2008;2:1-7)

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

“…Relapse was the only significant independent predictive risk factor for serious side effects in the multivariate analysis (OR 4.065; 95% CI 1.125-14.706; p = 0.032). The rate of relapse is reportedly 15%-60% [22][23][24][25]. In the present study, the incidence of AIP relapse was 23.8% (20/84), which was similar to previous reports.…”

Clinicoserological factors associated with response to steroid treatment and recurrence in patients with IgG4-related ophthalmic disease

“…The value of long-term low-dose maintenance corticosteroid therapy to avoid recurrence in autoimmune pancreatitis, a subtype of IgG4-RD, is well known 24. However, the duration of maintenance therapy has not yet been established 25. The results of our study showed the systemic maintenance of corticosteroids over 5 months could be suggested for initial treatment to reduce the risk of recurrence, and further prospective studies are needed to establish effective regimens of long-term low-dose corticosteroids to prevent recurrence.…”

Idiopathic Duct Centric Pancreatitis in Korea: A Clinicopathological Study of 14 Cases

“…21,22 Because AIP cases sometimes closely mimic pancreatic cancer, their responsiveness to steroid therapy is one of the important diagnostic criteria of AIP. 23 In our study, we used the AIP criteria published by Kim et al 10,13,14 As reported previously, 3 both types of AIP responded to steroid initially but only patients with LPSP developed recurrences. Interestingly, LPSP cases with recurrences exhibited extrapancreatic involvement more frequently than those without recurrences.…”