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J Hepatol. 2015 Mar;62(3):642-6. doi: 10.1016/j.jhep.2014.10.018. Epub 2014 Oct 18.

Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis.

Author information

1
University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
2
University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany; Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
3
University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany. Electronic address: cschramm@uke.de.

Abstract

BACKGROUND & AIMS:

In autoimmune hepatitis (AIH), relapse rates as high as 90% have been reported after treatment withdrawal. We therefore investigated, whether longer duration of treatment and proper patient selection could increase the long-term success rates after treatment withdrawal.

METHODS:

Following our previously published experience, treatment withdrawal was considered when biochemical remission was maintained under immunosuppressive monotherapy for at least 2 years. Remission was defined as repeatedly normal serum aminotransferase levels as well as normal IgG levels.

RESULTS:

Out of 288 patients with well-defined AIH, 28 patients were included. Median duration of treatment was 48.5 months (range 35-179) and a sustained remission was observed for 45 months (range 24-111). All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn. Using this strict approach, 15 patients (54%) remained in long-term remission after a median of 28 months follow-up (range 17-57) and 13 patients (46%) required reinstitution of treatment. Higher ALT and IgG levels - although within the normal range in all patients--were associated with the time to relapse. All patients who remained in remission had ALT levels less than half the ULN and IgG levels not higher than 12 g/L at the time of treatment withdrawal.

CONCLUSIONS:

Proper patient selection including a sustained complete biochemical remission on immunosuppressive monotherapy for a minimum of 2 years can markedly improve the success rates of treatment withdrawal. The interpretation of aminotransferase and IgG levels within the normal range could aid in predicting the risk of relapse.

KEYWORDS:

Autoimmune hepatitis; Drug withdrawal; Immunosuppressive therapy; Loss of remission; Predictors for relapse; Relapse; Remission; Treatment duration

PMID:
25457202
DOI:
10.1016/j.jhep.2014.10.018
[Indexed for MEDLINE]

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