Reply to the letter by A. Eshraghian et al. regarding “Oral steroid versus steroid pulse therapy for autoimmune pancreatitis”

Excerpt

Thank you for your interest in our article. Most autoimmune pancreatitis (AIP) reported in Japan is lymphoplasmacytic sclerosing pancreatitis (LPSP), and the pathogenesis of this entity is not clear. We previously reported, in our study with mouse models, that a reaction with a self-antigen, such as lactoferrin or carbonic anhydrase II, was an important trigger of AIP, occurring via a Th1-type immune reaction [1]. It has also been reported that inducible T-cell co-stimulator (ICOS)-positive regulatory T cells are important for the production of IgG4 through interleukin (IL)-10 [2]. The clinical course of LPSP is also unclear; however, it is known that there are many relapses [3]. The recurrence that happens after the ending of steroid therapy is a big problem in the treatment of AIP. New treatments using agents such as anti-tumor necrosis factor (TNF)-alpha and antagonists of IL-2 receptors might have the possibility of solving this problem. We agree with the necessity for performing experiments using these drugs. However, many problems about the safety of these drugs, such as their side effects, should be resolved. At present, it is thought that treatment with steroids is safest for AIP. …