Clinical Scenario

This protocol addresses confirmed type 1 autoimmune pancreatitis — also called lymphoplasmacytic sclerosing pancreatitis (LSCP) — as defined by the international consensus diagnostic criteria (ICDC). It applies specifically to this subtype and not to type 2 AIP (idiopathic duct centric pancreatitis / IDCP), which differs in natural history, diagnostic criteria, and management.

Previous Treatment — Goal Not Met

The standard first-line approach for type 1 AIP is corticosteroid induction with Prednisone. This protocol is indicated when that induction course fails to achieve complete remission by 4 weeks — the defined therapeutic endpoint. Non-achievement of this goal is the criterion that escalates care to this next-line protocol.

Next-Line Approach — Partial Overview

When corticosteroid induction does not achieve complete remission in type 1 AIP, the evidence-based next step involves induction with Rituximab; the complete structured regimen is available in the full protocol below.

References

The international consensus diagnostic criteria (ICDC) classify AIP as type 1 AIP or lymphoplasmacytic sclerosing pancreatitis, type 2 AIP or idiopathic duct centric pancreatitis (IDCP), or AIP not otherwise specified.

Because of the significant differences among type 1 and type 2 AIP with regard to natural history, diagnostic criteria, and management, the term AIP is restricted to lymphoplasmacytic sclerosing pancreatitis, whereas type 2 AIP is termed IDCP.

Rituximab induction

DOI: 10.1016/j.cgh.2019.04.052

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Type 1 AIP (Lymphoplasmacytic Sclerosing Pancreatitis) Without Complete Remission After Corticosteroid Induction