{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:21:14Z","timestamp":1790353274945,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Steroid therapy is the first-line treatment for autoimmune pancreatitis (AIP) with high response rates, although steroids can cause adverse events (AEs), such as diabetes mellitus (DM). The optimal initial steroid dose has not been well studied, and initiating high-dose steroid treatment may cause worsening of DM. Aims: The aim of this study was to evaluate the effect of the initial steroid dosage on treatment efficacy and diabetes mellitus in the management of autoimmune pancreatitis. Methods: A total of 81 AIP patients treated with steroids were divided into two groups based on the starting steroid dosage: a high-dose group (HD group; &gt;0.4 mg\/kg) and a low-dose group (LD group; \u22640.4 mg\/kg). Treatment efficacy (response rate, pancreatic volume), relapse rate, and DM worsening rate were analyzed. Results: Among the 81 patients, 58 received HD steroids, and 23 received LD steroids. The treatment response rate was 100% in both groups (58 vs. 23, p = 1), and the overall relapse rate was 29% vs. 26% (17 vs. 6, p = 0.79), with no significant difference. At 1 year, DM worsening occurred in 50% vs. 16% (25 vs. 3, p = 0.007), significantly more in the HD group. The risk factors for DM worsening were starting HD steroid treatment (OR 6.52, 95% CI 1.41\u201330.2, p = 0.01) and older age (OR 1.10 per year, 95% CI 1.01\u20131.19, p = 0.03). Conclusions: No significant difference in treatment efficacy was found between HD and LD steroid treatment for AIP. LD treatment may prevent DM worsening.<\/jats:p>","DOI":"10.3390\/diagnostics15212719","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:29:34Z","timestamp":1761661774000},"page":"2719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High vs. Low Initial Steroid Dose in Autoimmune Pancreatitis: Multicenter Cohort Study on Efficacy and Diabetes Worsening"],"prefix":"10.3390","volume":"15","author":[{"given":"Yuhei","family":"Iwasa","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-1787","authenticated-orcid":false,"given":"Takuji","family":"Iwashita","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"},{"name":"Department of Gastroenterology, Shiga University of Medical Science Hospital, Setatsukinowa-cho, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0564-8669","authenticated-orcid":false,"given":"Keisuke","family":"Iwata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7079-6222","authenticated-orcid":false,"given":"Ryuichi","family":"Tezuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Uemura","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2166-715X","authenticated-orcid":false,"given":"Akinori","family":"Maruta","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Iwata","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Ohashi","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensaku","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Gifu Prefectural General Medical Center, Department of Gastroenterology, Gifu 500-8717, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-2058","authenticated-orcid":false,"given":"Masahito","family":"Shimizu","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/BF02285209","article-title":"Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis","volume":"40","author":"Yoshida","year":"1995","journal-title":"Dig. Dis. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s00535-019-01658-7","article-title":"Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2016","volume":"55","author":"Masamune","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.2214\/ajr.170.5.9574610","article-title":"Autoimmune pancreatitis: CT and MR characteristics","volume":"170","author":"Irie","year":"1998","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00535-022-01857-9","article-title":"Amendment of the Japanese consensus guidelines for autoimmune pancreatitis, 2020","volume":"57","author":"Okazaki","year":"2022","journal-title":"J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/gut.51.1.1","article-title":"Autoimmune related pancreatitis","volume":"51","author":"Okazaki","year":"2002","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pan.2016.12.003","article-title":"International consensus for the treatment of autoimmune pancreatitis","volume":"17","author":"Okazaki","year":"2017","journal-title":"Pancreatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1053\/j.gastro.2007.11.023","article-title":"Substitution of aspartic acid at position 57 of the DQbeta1 affects relapse of autoimmune pancreatitis","volume":"134","author":"Park","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.cgh.2023.12.010","article-title":"Type 1 Autoimmune Pancreatitis in Europe: Clinical Profile and Response to Treatment","volume":"22","author":"Overbeek","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1111\/jdi.13791","article-title":"Factors affecting glycemic control in diabetes mellitus complicated by autoimmune pancreatitis","volume":"13","author":"Harai","year":"2022","journal-title":"J. Diabetes Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1097\/MPA.0000000000001007","article-title":"Relative Rise of Serum IgG4 Levels After Steroid Therapy for Autoimmune Pancreatitis Predicts the Likelihood of Relapse","volume":"47","author":"Suzuki","year":"2018","journal-title":"Pancreas"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5125","DOI":"10.3748\/wjg.v29.i35.5125","article-title":"Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level: A single-center, retrospective cohort study","volume":"29","author":"Zhou","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1136\/gut.2008.172908","article-title":"Standard steroid treatment for autoimmune pancreatitis","volume":"58","author":"Kamisawa","year":"2009","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s00535-007-2051-y","article-title":"Treatment for autoimmune pancreatitis: Consensus on the treatment for patients with autoimmune pancreatitis in Japan","volume":"42","author":"Ito","year":"2007","journal-title":"J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s00535-019-01615-4","article-title":"Insulin secretion improvement during steroid therapy for autoimmune pancreatitis according to the onset of diabetes mellitus","volume":"55","author":"Noguchi","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/01.mpa.0000202950.02988.07","article-title":"Influence of steroid therapy on the course of diabetes mellitus in patients with autoimmune pancreatitis: Findings from a nationwide survey in Japan","volume":"32","author":"Nishimori","year":"2006","journal-title":"Pancreas"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/00006676-200310000-00007","article-title":"Pancreatic endocrine and exocrine function and salivary gland function in autoimmune pancreatitis before and after steroid therapy","volume":"27","author":"Kamisawa","year":"2003","journal-title":"Pancreas"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"497","DOI":"10.2169\/internalmedicine.45.1565","article-title":"Long-term outcome of autoimmune pancreatitis after oral prednisolone therapy","volume":"45","author":"Nishino","year":"2006","journal-title":"Intern. Med."},{"key":"ref_18","first-page":"2621","article-title":"High-dose but not low-dose dexamethasone impairs glucose tolerance by inducing compensatory failure of pancreatic beta-cells in normal men","volume":"81","author":"Matsumoto","year":"1996","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/MPA.0000000000000044","article-title":"Comparable efficacy of low- versus high-dose induction corticosteroid treatment in autoimmune pancreatitis","volume":"43","author":"Buijs","year":"2014","journal-title":"Pancreas"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1007\/s00535-016-1302-1","article-title":"Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: A long-term Japanese multicenter analysis of 510 patients","volume":"52","author":"Kubota","year":"2017","journal-title":"J. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1177\/0961203311402246","article-title":"Glucocorticoid-induced diabetes mellitus in patients with systemic lupus erythematosus treated with high-dose glucocorticoid therapy","volume":"20","author":"Ha","year":"2011","journal-title":"Lupus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.diabres.2015.02.010","article-title":"Risk factors for the development of glucocorticoid-induced diabetes mellitus","volume":"108","author":"Katsuyama","year":"2015","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.4143\/crt.2015.464","article-title":"A Pilot Study Evaluating Steroid-Induced Diabetes after Antiemetic Dexamethasone Therapy in Chemotherapy-Treated Cancer Patients","volume":"48","author":"Jeong","year":"2016","journal-title":"Cancer Res. Treat."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1136\/annrheumdis-2011-200702","article-title":"Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: A nested case-control analysis","volume":"71","author":"Dixon","year":"2012","journal-title":"Ann. Rheum. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/j.arth.2015.03.036","article-title":"High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review","volume":"30","author":"Mont","year":"2015","journal-title":"J. Arthroplast."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/21\/2719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:29:39Z","timestamp":1761661779000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/21\/2719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":25,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["diagnostics15212719"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15212719","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]}}}