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Steroid discontinuation resulted in relapses among patients with autoimmune pancreatitis
Patients with autoimmune pancreatitis who discontinued steroid treatment often relapsed and had their disease occur in the pancreas or biliary tract, according to study data.
Researchers conducted an analysis of 1,064 patients across 10 countries who met international criteria for either autoimmune pancreatitis (AIP) type 1 (n=978) or type 2 (n=86). They compiled data on patient treatment regimens, relapses and subsequent disease consequences. Steroids were used as initial treatment as opposed to surgery or conservative approaches for 74% of AIP type 1 patients and 62% of type 2 patients (P=.01). Clinical remission occurred in 99.6% of type 1 patients and 92.3% of type 2 patients using steroids compared with conservative methods (55.2% vs. 66.7%, respectively).
When steroid therapy was discontinued, relapse was more common among AIP type 1 patients (31% vs. 9%; P<.001) than type 2 patients. It primarily occurred in the biliary tract (50.6%) and/or pancreas (42.9%) for AIP type 1 and was contained to the pancreas in type 2 patients. Ninety-five percent of relapsed type 1 AIP patients returned to remission after steroid reintroduction, with or without alternative medications including azathioprine.
Researchers noted that pancreatic duct stones occurred in 7% of type 1 patients and were more likely among those with at least one relapse compared with patients who did not relapse (14.4% vs. 4%; P<.001). Incident cancers, including gastric, lung and prostate, were uncommon. Five men developed pancreatic cancer during follow-up at a median age of 77 years.
“We have shown that most [AIP] patients are treated with steroids for predominantly pancreatobiliary manifestations of their disease,” the researchers concluded. “Disease relapses are common after steroid discontinuation, and typically occur in the pancreas and/or biliary system. Additional studies are needed to compare different treatment strategies for maintaining disease remission.”