TABLE 2.

Preferred Mayo Clinic initial steroid treatment protocol for autoimmune pancreatitis and immunoglobulin G4 (IgG4)-associated cholangitis

Initial steroid regimen

Prednisone 40 mg/day oral for 4 weeks, then taper by 5 mg/week for a total of 11 weeks of treatment

Imaging

Follow-up evaluation If biliary stent placed on presentation: ERCP repeated 6 to 8 weeks after initiating treatment; if improvement in strictures noted (no tight strictures), stents removed If no biliary stent placed, then no follow-up imaging performed

Laboratory evaluation

Initial Serum bilirubin, AP, AST, ALT, IgG4, CA 19-9 at baseline

Follow-up evaluation Biliary stent in place: Earlier-described laboratory tests repeated 4 weeks after stent removal (see earlier for stent removal protocol), then every 8 to12 weeks thereafter No biliary stent: Earlier described laboratory tests repeated 6 to 8 weeks after initiating steroid treatment; if a response is documented, then laboratory tests repeated every 8 to 12 weeks thereafter

ALT Alanine aminotransferase; AP Alkaline phosphatase; AST Aspartate aminotransferase; CA Carbohydrate antigen 19-9; ERCP Endoscopic retrograde cholangiopancreatography. Adapted with permission from reference 43