Long‐Term Outcomes of Low‐Dose Steroid Induction for Autoimmune Pancreatitis: A Multicenter Retrospective Study Identifying Risk Factors for Relapse
Yuhei Iwasa, Akinori Maruta, Keisuke Iwata, Hidetaka Kuroda, Shinya Uemura, Shota Iwata, Yosuke Ohashi, Naoki Mita, Hironao Ichikawa, Masahito ShimizuABSTRACT
Background
Steroids are the first‐line treatment for autoimmune pancreatitis (AIP); however, the impact of lower initial doses on relapse remains unclear.
Methods
Ninety patients were divided into high‐dose (HD; > 0.4 mg/kg/day) and low‐dose (LD; ≤ 0.4 mg/kg/day) induction groups. The treatment response, relapse rate, and predictors of relapse were evaluated.
Results
Sixty‐two and 28 patients received HD and LD steroid induction. The treatment response (100% vs. 100%, p > 0.99), relapse rates (33.9% vs. 32.1%, p > 0.99) and relapse‐free survival (hazard ratio [HR]: 0.86; log‐rank test, p = 0.99) did not differ significantly between the groups. Multivariable analysis identified discontinuation of maintenance treatment within 3 years (HR: 5.32, p = 0.0004), larger pancreatic volume (HR: 1.02, p = 0.01), and a smaller IgG4 reduction rate at 1 month after initiation of steroid treatment (HR: 0.99, p = 0.02) as independent predictors of relapse. In contrast, LD steroid induction was not identified as a risk factor for relapse (HR: 0.99, p = 0.99).
Conclusions
There were no significant differences between LD and HD steroid induction in terms of treatment efficacy or long‐term outcomes in patients with AIP.