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

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 All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn.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.

• Authors: Johannes Hartl, Hanno Ehlken, Christina Weiler-Normann, Marcial Sebode, Benno Kreuels, Nadine Pannicke, Roman Zenouzi, Claudia Glaubke, Ansgar W Lohse, Christoph Schramm
• Journal: Journal of hepatology (J Hepatol) Vol. 62 Issue 3 Pg. 642-6 (Mar 2015) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 25457202 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Immunoglobulin G
• Immunosuppressive Agents
• Alanine Transaminase

Topics

• Adolescent
• Adult
• Aged
• Alanine Transaminase (blood)
• Child
• Female
• Hepatitis, Autoimmune (blood, drug therapy, immunology)
• Humans
• Immunoglobulin G (blood)
• Immunosuppressive Agents (administration & dosage)
• Liver (metabolism)
• Male
• Middle Aged
• Patient Selection
• Recurrence
• Remission Induction
• Time Factors
• Withholding Treatment
• Young Adult