To determine the frequency of a sustained remission and to assess the long-term prognosis of relapse and
retreatment, 66 patients with severe
hepatitis B surface antigen-negative
chronic active hepatitis and prolonged follow-up after initial
corticosteroid withdrawal (mean, 10 +/- 0.4 yr) were evaluated. Selection of patients was made from among 206 cases of severe disease. Twenty-four patients (36%) sustained remission for at least 5 yr (mean, 11 +/- 0.6 yr) after initial
therapy, and 42 (64%) relapsed and were retreated. Patients who sustained remission had shorter durations of illness before
therapy (8 +/- 1 vs. 14 +/- 2 mo, p less than 0.05) and they had greater laboratory improvements during treatment. The frequencies of
cirrhosis and death were not significantly greater in patients who relapsed. Of the 42 patients who relapsed, 9 (21%) ultimately entered a sustained remission after
retreatment. Remission for at least 5 yr was possible in 33 of the 66 patients (50%). Major
drug complications developed more commonly in those who relapsed and required
retreatment (59% vs. 29%, p less than 0.05). We conclude that 50% of patients who enter remission during initial
therapy may ultimately achieve a sustained remission, especially if their disease is of short duration and adequately suppressed during treatment. Relapse does not affect long-term prognosis, but
retreatment is associated with more side effects.