Autoimmune Pancreatitis: An Update

Aravind Sugumar; Suresh Chari

Disclosures

Expert Rev Gastroenterol Hepatol. 2009;3(2):197-204. 

In This Article

Treatment

Autoimmune pancreatitis is exquisitely sensitive to corticosteroid therapy.[18] This is one of the hallmarks of this disease. While AIP may remit spontaneously,[69] recent reports suggest that treatment with corticosteroids hastens recovery, decreases complications and delays relapses.[16,17,18,19,70] Initiation of therapy with corticosteroid should begin only after ruling out other pancreatic diseases especially pancreatic cancer. While corticosteroids are the treatment of choice for inducing remission of AIP, its dosage, duration and taper regimens vary. There is considerable variation in the way patients are treated in the USA as opposed to Asia.[70,71,72,73] The suggested a starting dose of 30-40 mg/day (0.6 mg/kg). Majority of patients have a significant improvement in symptoms with in 2-3 weeks of starting treatment. Radiological and serological remission is much more variable. It takes months before the serum IgG4 normalizes. The structural changes when followed up radiologically show varied improvement based on how much fibrosis is present as opposed to inflammation. Inflammatory changes are more like to resolve early. After 4 weeks of therapy, if clinical, radiological and serological tests point to or trend to remission we taper the prednisone by 5 mg/week until gone. Physicians in Japan favor a more prolonged taper with maintenance therapy with low dose prednisone (2.5-10 mg). We have also treated two patients with rituximab as they could not tolerate corticosteroid. More prospective trials are needed in order to determine the appropriate dose, duration and the role of stents and other medications in AIP.

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