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When Can Patients with Autoimmune Hepatitis Stop Treatment?

Summary and Comment |
March 19, 2014

When Can Patients with Autoimmune Hepatitis Stop Treatment?

  1. Atif Zaman, MD, MPH

Full resolution of disease, based on both laboratory and histologic criteria, is the best predictor of successful permanent drug withdrawal.

  1. Atif Zaman, MD, MPH

Autoimmune hepatitis (AIH) is typically treated with azathioprine with or without prednisone. Indefinite drug therapy has been standard in AIH; however, some patients may achieve permanent drug withdrawal. To describe how often this occurs, the characteristics of patients who achieve it, and suggested management protocols, investigators conducted a literature review of articles on treatment outcomes, relapse, and remission in AIH published between 1972 and 2014.

The main points of the review included the following:

  • The frequency of a treatment-free state varied from 19% to 40% in patients followed for ≥3 years.

  • The most valid predictor of a durable, treatment-free state in which relapse is prevented is induction of a complete laboratory resolution (i.e., normal levels of alanine aminotransferase and aspartate aminotransferase) and histological resolution (i.e., absence of inflammation and plasma cells on liver biopsy) prior to drug withdrawal.

  • Patients who achieve complete response to therapy (based on laboratory and histologic markers) within 36 months are candidates for treatment withdrawal.

  • Patients who do not completely respond to treatment are candidates for long-term maintenance therapy. In these patients, an attempt should be made to reduce therapy doses, as guided by monitoring of laboratory parameters, to ensure they remain normal.

Comment

This review article addresses an important clinical situation in the management of autoimmune hepatitis — whether treatment can be stopped and, if so, how to go about it. Although the recommendations are not based on strong, well-validated evidence, they are based on sound judgment that is useful in clinical practice.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex

Citation(s):

Reader Comments (1)

arun chatterjee Physician, Pediatrics/Adolescent Medicine, personal clinic

as the recommendation is based on retrospective parameters it will be prudent to apply it prospectively so as to use it as protocol.

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