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

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Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis. / Hartl, Johannes; Ehlken, Hanno; Weiler-Normann, Christina; Sebode, Marcial; Kreuels, Benno; Pannicke, Nadine; Zenouzi, Roman; Glaubke, Claudia; Lohse, Ansgar W; Schramm, Christoph.

in: J HEPATOL, Jahrgang 62, Nr. 3, 01.03.2015, S. 642-6.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Hartl, J, Ehlken, H, Weiler-Normann, C, Sebode, M, Kreuels, B, Pannicke, N, Zenouzi, R, Glaubke, C, Lohse, AW & Schramm, C 2015, 'Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis', J HEPATOL, Jg. 62, Nr. 3, S. 642-6. https://doi.org/10.1016/j.jhep.2014.10.018

APA

Hartl, J., Ehlken, H., Weiler-Normann, C., Sebode, M., Kreuels, B., Pannicke, N., Zenouzi, R., Glaubke, C., Lohse, A. W., & Schramm, C. (2015). Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis. J HEPATOL, 62(3), 642-6. https://doi.org/10.1016/j.jhep.2014.10.018

Vancouver

Hartl J, Ehlken H, Weiler-Normann C, Sebode M, Kreuels B, Pannicke N et al. Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis. J HEPATOL. 2015 Mär 1;62(3):642-6. https://doi.org/10.1016/j.jhep.2014.10.018

Bibtex

@article{4425a8ed573043a0bf7ce504c4faf9ef,
title = "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.",
author = "Johannes Hartl and Hanno Ehlken and Christina Weiler-Normann and Marcial Sebode and Benno Kreuels and Nadine Pannicke and Roman Zenouzi and Claudia Glaubke and Lohse, {Ansgar W} and Christoph Schramm",
note = "Copyright {\textcopyright} 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.",
year = "2015",
month = mar,
day = "1",
doi = "10.1016/j.jhep.2014.10.018",
language = "English",
volume = "62",
pages = "642--6",
journal = "J HEPATOL",
issn = "0168-8278",
publisher = "Elsevier",
number = "3",

}

RIS

TY - JOUR

T1 - Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis

AU - Hartl, Johannes

AU - Ehlken, Hanno

AU - Weiler-Normann, Christina

AU - Sebode, Marcial

AU - Kreuels, Benno

AU - Pannicke, Nadine

AU - Zenouzi, Roman

AU - Glaubke, Claudia

AU - Lohse, Ansgar W

AU - Schramm, Christoph

N1 - Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.jhep.2014.10.018

DO - 10.1016/j.jhep.2014.10.018

M3 - SCORING: Journal article

C2 - 25457202

VL - 62

SP - 642

EP - 646

JO - J HEPATOL

JF - J HEPATOL

SN - 0168-8278

IS - 3

ER -