Comparable efficacy of low and high dose induction corticosteroid treatment in
autoimmune pancreatitis
J. Buijs¹, M.J. van Heerde¹, B.E. Hansen¹,², K. Biermann3, F.P. Vleggaar4, M.A. Brink5, E.J.
Kuipers¹,6, M.J. Bruno¹, H.R. van Buuren¹
¹ Department of Gastroenterology and Hepatology, Erasmus University Medical Center,
Rotterdam, the Netherlands
² Department of Public Health, Erasmus University Medical Center, Rotterdam, the
Netherlands
3
Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
4
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the
Netherlands
5
Department of Gastroenterology, Meander Medical Center, Amersfoort, the Netherlands
6
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the
Netherlands
Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis highly responsive to
corticosteroids. The usually recommended dosage of prednisone for remission induction is 0.6
mg/kg/day, resulting in daily starting doses of 30 – 60 mg. This recommended dosage is
largely based on empirical data and lacks scientific base. Potentially, high dose corticosteroid
treatment is associated with significant side effects, particularly in a population characterised
by relative advanced age, diabetes and obstructive jaundice at presentation. The rationale for
high dose treatment could also be questioned considering the well-established sensitivity for
corticosteroids in AIP patients. We therefore compared the efficacy of treatment and the
incidence of worsening glucose tolerance in AIP patients treated with different doses of
steroid induction therapy.
A retrospective survey was conducted of patients diagnosed with AIP between May 1992 and
August 2011. Clinical, laboratory and image findings were assessed before treatment and at 1,
3 and 6 months after starting treatment. Differences between groups treated with different
initial doses of prednisone were compared using linear and logistic regression analysis.
A total of 37 patients (33 males; median age 65 years) were included. The most frequent
presenting symptoms included jaundice, pancreatic insufficiency, weight loss and (mild)
abdominal pain. Four patients were treated with an initial dose of prednisone of 10 mg/d, 2
patients with 15 mg/d, 6 patients with 20 mg/d, 11 patients with 30 mg/d, 12 patients with 40
mg/d and 2 patients with 60 mg/d. With respect to the baseline characteristics including
gender, age, presenting symptoms, laboratory and imaging results, there was no significant
difference in administered dose of prednisone. During a clinical follow-up period of 6 months,
37/38 (97%) patients achieved clinical response. Symptomatic response after 1, 3 and 6
months of treatment was not associated with doses of prednisone. Treatment response
according to imaging studies and laboratory parameters was also comparable. There was no
significant difference in worsening of glucose tolerance. (Table 1)
Conclusions: Symptomatic, radiological and biochemical improvement was comparable for
AIP patients treated with variable induction doses of prednisone. Based on these retrospective
data it may be questioned whether high dose prednisone therapy is truly indicated in patients
presenting with AIP.
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