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, Vol. 62, No. 3, 01.03.2015, p. 642-6.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn.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 -