Impact of Steroid Pulse Therapy on Early Treatment Response and Relapse in Type 1 Autoimmune Pancreatitis

Despite the recommendation of steroid therapy for type 1 autoimmune pancreatitis (AIP), the value of steroid pulse therapy remains unclear. This study aimed to assess the efficacy and safety of steroid pulse therapy in patients with AIP.

Of 121 patients with type 1 AIP who were identified, 116 with adequate follow-up data were included in the analysis. Patients were classified into four groups according to the initial treatment modality-pulse therapy alone (Pulse alone group), pulse therapy followed by oral steroid therapy (Pulse + PSL group), conventional oral steroid therapy (PSL group), and observation without treatment (Observation group)-and short- and long-term clinical response, relapse rates, and steroid-associated adverse events were compared across these groups. The numbers of patients in the Pulse alone, Pulse + PSL, PSL, and Observation groups were 12, 13, 68, and 23, respectively. After 2 weeks of steroid initiation, steroid pulse groups (Pulse alone and Pulse + PSL group) showed a significantly greater reduction in serum IgG4 levels than the PSL group (p = 0.048). Pulse + PSL was associated with a significantly lower relapse rate than PSL (log-rank test p = 0.02; multivariate Cox regression p = 0.048), with no differences in adverse events. Rates of relapse and adverse events did not differ significantly between the Pulse alone and Observation groups.

Steroid pulse therapy may serve as a useful therapeutic option when conducting a steroid trial and may help reduce relapse rate in the management of type 1 AIP.