Low-dose corticosteroid therapy after multiple relapses of severe HBsAg-negative chronic active hepatitis
✍ Scribed by Albert J. Czaja
- Publisher
- John Wiley and Sons
- Year
- 1990
- Tongue
- English
- Weight
- 707 KB
- Volume
- 11
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
To evaluate the efficacy of low-dose corticosteroid therapy after multiple relapses of severe IBsAgnegative chronic active hepatitis, 22 patients who had relapsed on 3.4 & 0.4 occasions (range = two to seven relapses) were treated with the lowest dose of medication necessary to ameliorate symptoms and maintain serum AST activity below five-fold normal. Results were compared with those in 31 patients who had received conventional retreatments after 3.4 * 0.3 relapses (range = two to eight relapses). During 44 * 7 mo of low-dose therapy (range = 9 to 149 mo), one patient (5%) entered sustained remission, 16 patients (72%) continued treatment, two patients (9%) received liver transplantations, two patients (9%) died of liverrelated complications and one patient (6%) died of a nonliver-related cause. Drug-related side effects im- proved in 11 of 13 patients who had acquired them during conventional therapy (85%). The median dose of prednisone was 7.5 mg daily (range = 1 to 17.5 mg) with and without azathioprine. Thirteen patients received long-term treatment consisting of 10 mg or less of prednisone only. Patients receiving conventional treatment entered remission more frequently than those on low-dose therapy (97% vs. 36%, p < 0.001) but they relapsed after drug withdrawal (53% vs. 87%, p > O.l), required continuous therapy (65% vs. 72%, p > 0.1) and died of liver-related complications (10% vs. 9%) as commonly as those receiving low-dose therapy. W e conclude that low-dose corticosteroid therapy in patients who have experienced multiple relapses has similar efficacy and less morbidity than conventional retreatments. (HEPATOLOGY 1990;11:1044-
1049.)
Corticosteroid therapy is effective in inducing clinical, biochemical and histological remission in most patients with severe autoimmune (HBsAg-negative) CAH (1-4). Unfortunately, up to 87% of patients who satisfy criteria for remission relapse soon after medication is discontinued (5-7). Reinstitution of therapy usually induces remission again, but drug withdrawal is commonly