Correlation between long-term outcome and steroid therapy in type 1 autoimmune pancreatitis: relapse, malignancy and side effect of steroid. (November 2015)

• Record Type: Journal Article
• Authors: Shimizu, Shuya; Naitoh, Itaru; Nakazawa, Takahiro; Hayashi, Kazuki; Miyabe, Katsuyuki; Kondo, Hiromu; Nishi, Yuji; Yoshida, Michihiro; Umemura, Shuichiro; Hori, Yasuki; Kato, Akihisa; Okumura, Fumihiro; Sano, Hitoshi; Hirata, Yoshikazu; Takada, Hiroki; Ohara, Hirotaka; Joh, Takashi
• Is Part Of: Scandinavian journal of gastroenterology. Volume 50:Number 11(2015)
• Page Start: 1411
• Page End: 1418
• Publication Date: 2015-11
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Objectives.</italic> </bold> Autoimmune pancreatitis (AIP) responds well to corticosteroid therapy (CST), and CST is essential to induce remission. However, the correlation between long-term outcome and CST has not been evaluated. We aimed to clarify the correlation between long-term outcome of AIP and CST. <bold><italic>Material and methods.</italic></bold> We retrospectively evaluated relapse, risk of malignancy and side effects of CST by focusing on the correlation with CST in 84 patients with type 1 AIP. <bold><italic>Results.</italic></bold> The incidence of relapse was 23.8%. The frequency of relapse after CST administration was significantly lower in patients taking CST for >6 months than in those who did not (22% versus 67%; <italic>p</italic> = 0.036). The incidence of malignancy was 10.7%. The standardized incidence ratio of malignancy was 2.14 [95% confidence interval 0.74–3.54]. There were no significant correlations between development of malignancy and CST. The incidences of total and serious side effects due to CST were 75% and 19.1%, respectively. Relapse was the only significant independent predictive risk factor for serious side effects in a multivariate analysis (odds ratio 4.065; 95% confidence interval 1.125–14.706; <italic>p</italic> = 0.032). The cumulative dose of corticosteroid was significantly higher in patients with serious side effects than in those without (12, 645 mg versus 7322 mg; <italic>p</italic> = 0.041). <bold><italic>Conclusions.</italic></bold> CST reduces relapse of AIP. However, CST causes serious side effects, particularly in relapsing patients. Alternative maintenance therapy to prevent relapse is needed.</p> </abstract>