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Long-Term Outcomes and Predictors of Delayed Steroid Initiation in Type 1 Autoimmune Pancreatitis Initially Managed
Yasuhiro Kuraishi1, Akira Nakamura1, Masafumi Minamisawa1
1Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan.
Background/Purpose:
Although type 1 autoimmune pancreatitis (AIP) responds well to corticosteroids, spontaneous remission can also occur. This study evaluated long-term outcomes and predictors of delayed steroid initiation in AIP patients initially managed conservatively.
Methods:
Type 1 AIP patients diagnosed between 2003 and 2024 were retrospectively reviewed. Patients not receiving corticosteroids within 6 months of diagnosis were defined as initially untreated. The primary outcome was cumulative steroid initiation, with secondary outcomes including spontaneous remission and relapse. Predictors were analyzed using Cox proportional hazards models.
Results:
Among 193 AIP patients, 62 were initially untreated and followed for a median of 94 months. Seventeen (24%) eventually required corticosteroids, with a 5-year cumulative incidence of 33%. Multivariate analysis identified that elevated serum IgG4 independently predicted subsequent steroid initiation (hazard ratio [HR] 5.26, p = 0.009), whereas spontaneous remission was protective (HR 0.26, p = 0.013). Spontaneous remission occurred in 63% (4-year cumulative incidence, 65%) and was less frequent in diffuse pancreatic enlargement. Relapse occurred in 46% of remission cases (8-year cumulative incidence, 59%), with renal involvement predicting recurrence.
Conclusions:
Nearly one-third of initially untreated AIP patients required corticosteroids during long-term follow-up. Elevated IgG4 predicted steroid initiation, while spontaneous remission indicated a reduced likelihood.
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