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Long-term treatment reduction and steroids withdrawal in children with autoimmune hepatitis: a single centre experience on 55 children.

AbstractBACKGROUND:
The combination of corticosteroids and azathioprine is the standard therapy for autoimmune hepatitis. The aim of this study was to describe our experience on long-term corticosteroid doses reducing and withdrawal in a large cohort of children with autoimmune hepatitis (AIH).
METHODS:
All children presenting with AIH in our institution, from 1990 to 2006, were retrospectively included.
RESULTS:
The study population included 55 children [38 females, 17 males, median age 8 years (ranging from 0.8 to 15)] with type 1 (74.5%), type 2 (20%) or seronegative (5.5%) AIH. The diagnosis was made in 41 of them at the time of acute hepatitis (75%); the other 14 were diagnosed as chronic liver disease (25%). Treatment consisted of corticosteroids and azathioprine in 45 patients or corticosteroids alone in five patients. Complete remission was obtained within 1 year in 31 (69%) patients. The median initial dose of corticosteroids was 1.6 mg/kg/day, and the dose was progressively reduced to 0.32 mg/kg/day at 1 year, 0.24 mg/kg/day at 3 years, 0.11 mg/kg/day at 5 years and 0.05 mg/kg/day at 10 years. Corticosteroids withdrawal was possible in 0% of patients at 1 year, 75% at 3 years, 78% at 5 years and 90% at 10 years. At the end of follow-up, azathioprine was maintained in 36 patients (80%). Total treatment withdrawal was obtained in four patients.
CONCLUSION:
Our results strongly confirm that long-term corticosteroids withdrawal is possible in a large majority of children with autoimmune hepatitis.
AuthorsJérôme Dumortier, Carlos Torres Arita, Christine Rivet, Catherine LeGall, Raymonde Bouvier, Nicole Fabien, Olivier Guillaud, Sophie Collardeau-Frachon, Jean-Yves Scoazec, Alain Lachaux
JournalEuropean journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 21 Issue 12 Pg. 1413-8 (Dec 2009) ISSN: 1473-5687 [Electronic] England
PMID19907227 (Publication Type: Journal Article)
Chemical References
  • Glucocorticoids
  • Azathioprine
  • Prednisone
Topics
  • Adolescent
  • Azathioprine (administration & dosage, therapeutic use)
  • Child
  • Child, Preschool
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Glucocorticoids (administration & dosage, therapeutic use)
  • Hepatitis, Autoimmune (drug therapy)
  • Humans
  • Infant
  • Male
  • Prednisone (administration & dosage, therapeutic use)
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome

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