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Journal of Gastroenterology

, Volume 52, Issue 8, pp 955–964 | Cite as

Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 510 patients

  • Kensuke Kubota
  • Terumi Kamisawa
  • Kazuichi Okazaki
  • Shigeyuki Kawa
  • Kenji Hirano
  • Yoshiki Hirooka
  • Kazushige Uchida
  • Hideyuki Shiomi
  • Hirotaka Ohara
  • Kyoko Shimizu
  • Norikazu Arakura
  • Atsushi Kanno
  • Junichi Sakagami
  • Takao Itoi
  • Tetsuhide Ito
  • Toshiharu Ueki
  • Takayoshi Nishino
  • Kazuo Inui
  • Nobumasa Mizuno
  • Hitoshi Yoshida
  • Masanori Sugiyama
  • Eisuke Iwasaki
  • Atshishi Irisawa
  • Toru Shimosegawa
  • Yoshifumi Takeyama
  • Tsutomu Chiba
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

The effect of maintenance steroid treatment (MST) in reducing the risk of relapse in patients with autoimmune pancreatitis (AIP) remains under debate. The aim of this study was to validate the effect of MST on AIP administered in accordance with the 2010 Japanese consensus guidelines.

Methods

The clinical data of patients with (n = 510) from 22 high-volume centers in Japan were studied. The primary endpoints were the relapse rates (RRs) in patients administered MST versus those not administered MST. The secondary endpoints were the optimal dose and duration of MST in terms of steroid toxicity and the predictors of relapse.

Results

The RRs were 10.0% within 1 year, 25.8% within 3 years and 35.1% within 5 years. The RR in the steroid therapy group reached a plateau at 42.7% at 7 years. In terms of the optimal dosage, the overall RR in the MST 5 mg/day group was 26.1%, which was significantly lower than that in the group which had discontinued steroid therapy (45.2%; p = 0.023) or was receiving MST at 2.5 mg/day (43.4%, p = 0.001). The RRs in the group receiving MST at ≥5 mg/day versus the patient group receiving MST at <5 mg/day were 10.6 vs. 10.3% within 1 year, 23.5 vs. 32.9% within 3 years and 32.2 vs. 41.3% within 5 years, respectively (log-rank, p = 0.028). The best cutoff value of the total steroid dose for serious steroid toxicity was 6405 mg, with a moderate accuracy of 0.717 determined using the area under the curve. Presence of diffuse pancreatic swelling [odds ratio OR) 1.745; p = 0.008) and MST at >5 mg/day were identified as predictors of relapse (OR 0.483; p = 0.001).

Conclusions

The RR could continue to increase for 7 years even under MST. Based on our analysis of the side effects of steroid therapy, MST at 5 mg/day for 2 (total 4625 mg) to 3 (total 6425 mg) years might be a rational and safe therapeutic strategy in terms of keeping the RR to <30% while avoiding potential steroid toxicity.

Keywords

Autoimmune pancreatitis Maintenance steroid treatment Relapse rate Steroid toxicity 

Notes

Acknowledgements

This work was supported in part by the Health and Labor Sciences Research Grants for research on intractable diseases (Research on IgG4-related disease) from Ministry of Health, Labor and Welfare of Japan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  • Kensuke Kubota
    • 1
  • Terumi Kamisawa
    • 2
  • Kazuichi Okazaki
    • 3
  • Shigeyuki Kawa
    • 4
  • Kenji Hirano
    • 5
  • Yoshiki Hirooka
    • 6
  • Kazushige Uchida
    • 3
  • Hideyuki Shiomi
    • 7
  • Hirotaka Ohara
    • 8
  • Kyoko Shimizu
    • 9
  • Norikazu Arakura
    • 10
  • Atsushi Kanno
    • 11
  • Junichi Sakagami
    • 12
  • Takao Itoi
    • 13
  • Tetsuhide Ito
    • 14
  • Toshiharu Ueki
    • 15
  • Takayoshi Nishino
    • 16
  • Kazuo Inui
    • 17
  • Nobumasa Mizuno
    • 18
  • Hitoshi Yoshida
    • 19
  • Masanori Sugiyama
    • 20
  • Eisuke Iwasaki
    • 21
  • Atshishi Irisawa
    • 22
  • Toru Shimosegawa
    • 11
  • Yoshifumi Takeyama
    • 23
  • Tsutomu Chiba
    • 24
  1. 1.Department of EndoscopyYokohama City University HospitalYokohamaJapan
  2. 2.Department of Internal MedicineTokyo Komagome Metropolitan HospitalTokyoJapan
  3. 3.Department of Gastroenterology and HepatologyKansai Medical UniversityHirakataJapan
  4. 4.Center for Health, Safety and Environmental ManagementShinshu UniversityMatsumotoJapan
  5. 5.Department of Gastroenterology, Graduate School of MedicineTokyo UniversityTokyoJapan
  6. 6.Department of EndoscopyNagoya University HospitalNagoyaJapan
  7. 7.Department of Gastroenterology, Graduate School of MedicineKobe UniversityKobeJapan
  8. 8.Department of Community-Based Medical Education, Graduate School of MedicineNagoya City UniversityNagoyaJapan
  9. 9.GastroenterologyTokyo Women’s Medical UniversityTokyoJapan
  10. 10.Department of Gastroenterology, Graduate School of MedicineShinshu UniversityMatsumotoJapan
  11. 11.Department of Gastroenterology, Graduate School of MedicineTohoku UniversitySendaiJapan
  12. 12.Department of Gastroenterology and HepatologyKyoto Prefectural University of MedicineKyotoJapan
  13. 13.Department of GastroenterologyTokyo Medical UniversityTokyoJapan
  14. 14.Department of Medicine and Bioregulatory Science, Graduate School of MedicineKyushu UniversityFukuokaJapan
  15. 15.Department of Gastroenterology, Chikushi HospitalFukuoka UniversityFukuokaJapan
  16. 16.Department of Gastroenterology, Yachiyo HospitalTokyo Women’s Medical UniversityTokyoJapan
  17. 17.Department of Gastroenterology, Second Teaching HospitalFujita Health UniversityToyoakeJapan
  18. 18.Department of GastroenterologyAichi Cancer CenterNagoyaJapan
  19. 19.Department of Gastroenterology, School of MedicineShowa UniversityTokyoJapan
  20. 20.Department of Surgery, School of MedicineKyorin UniversityTokyoJapan
  21. 21.Division of Gastroenterology and Hepatology, Department of Internal MedicineKeio UniversityTokyoJapan
  22. 22.Department of Gastroenterology, Aizu Medical CenterFukushima Medical UniversityFukushimaJapan
  23. 23.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKinki University Faculty of MedicineOsakaJapan
  24. 24.Gastroenterology, Graduate School of MedicineKyoto UniversityKyotoJapan

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