Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

• Published in: Journal of gastroenterology Vol. 46; no. 5; pp. 696 - 704
• Main Authors: Tomiyama, Takashi, Uchida, Kazushige, Matsushita, Mitsunobu, Ikeura, Tsukasa, Fukui, Toshiro, Takaoka, Makoto, Nishio, Akiyoshi, Okazaki, Kazuichi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.05.2011; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Administration, Oral; Aged; Aged, 80 and over; Alanine transaminase; Autoimmune Diseases - drug therapy; Autoimmune Diseases - physiopathology; Bile Ducts - pathology; Biliary Tract; Colorectal Surgery; Constriction, Pathologic - drug therapy; Constriction, Pathologic - etiology; Corticosteroids; Drug therapy; Female; Follow-Up Studies; Gastroenterology; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Hepatology; Humans; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methylprednisolone - administration & dosage; Methylprednisolone - therapeutic use; Middle Aged; Original Article—Liver; Pancreas; Pancreatitis; Pancreatitis - drug therapy; Pancreatitis - immunology; Pancreatitis - physiopathology; Prednisolone; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Pulse Therapy, Drug; Retrospective Studies; Surgical Oncology; Time Factors; Treatment Outcome; Bile duct stricture; Autoimmune pancreatitis (AIP); Steroid pulse therapy; Diabetes mellitus; Pancreatic cancer
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-010-0361-y

Background The efficacy of oral steroid therapy for autoimmune pancreatitis (AIP) is well known, and oral prednisolone treatment is most usually commenced at 30–40 mg/day, but there have been few reports about comparative studies of oral steroid therapy and steroid pulse therapy as the initial treatment for AIP. We studied the clinical course and image findings to estimate the utility of steroid pulse therapy for AIP, comparing it with oral steroid therapy. Methods Laboratory and image findings were assessed retrospectively in 11 patients who received steroid pulse therapy, and the findings were compared to those in 10 patients who received conventional oral steroid therapy. Results Change in pancreatic size showed no significant difference between the therapies after 2 weeks of treatment. Significant improvement of lower bile duct strictures after 2 weeks of treatment and that of immunoglobulin values within 6 months were shown with both therapies. However, steroid pulse therapy showed significant improvement of γ-guanosine triphosphate (GTP) in 2 weeks and of alanine aminotransferase (ALT) in 2 and 8 weeks, compared with oral steroid therapy. Moreover, there was one patient in whom the lower bile duct stricture was not improved by oral steroid therapy, but it did show improvement with steroid pulse therapy. Conclusions Initial steroid pulse therapy is a beneficial alternative to oral steroid therapy for the improvement of bile duct lesions. In future, the accumulation of a larger number of patients receiving steroid pulse therapy is needed, and prospective studies will be required.