Relapse is almost universal after withdrawal of immunosuppressive medication in patients with autoimmune hepatitis in remission

被引:178
|
作者
van Gerven, Nicole M. F. [1 ]
Verwer, Bart J. [1 ]
Witte, Birgit I. [2 ]
van Hoek, Bart [3 ]
Coenraad, Minneke J. [3 ]
van Erpecum, Karel J. [4 ]
Beuers, Ulrich [5 ]
van Buuren, Henk R. [6 ]
de Man, Rob A. [6 ]
Drenth, Joost P. H. [7 ]
den Ouden, Jannie W. [8 ]
Verdonk, Robert C. [9 ]
Koek, Ger H. [10 ]
Brouwer, Johannes T. [11 ]
Guichelaar, Maureen M. J. [12 ]
Mulder, Chris J. J. [1 ]
van Nieuwkerk, Karin M. J. [1 ]
Bouma, Gerd [1 ]
机构
[1] Vrije Univ Amsterdam, Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, Med Ctr, Dept Epidemiol & Biostat, Amsterdam, Netherlands
[3] Leiden Univ, Med Ctr, Dept Gastroenterol & Hepatol, Leiden, Netherlands
[4] Univ Med Ctr Utrecht, Dept Gastroenterol & Hepatol, Utrecht, Netherlands
[5] Univ Amsterdam, Acad Med Ctr, Dept Gastroenterol & Hepatol, NL-1105 AZ Amsterdam, Netherlands
[6] Erasmus Univ, Med Ctr, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands
[7] Radboud Univ Nijmegen, Med Ctr, Dept Gastroenterol & Hepatol, NL-6525 ED Nijmegen, Netherlands
[8] Haga Hosp, Dept Gastroenterol & Hepatol, The Hague, Netherlands
[9] Univ Groningen, Univ Med Ctr Groningen, Dept Gastroenterol & Hepatol, Groningen, Netherlands
[10] Univ Med Ctr Maastricht, Dept Gastroenterol & Hepatol, Maastricht, Netherlands
[11] Reinier de Graaf Med Ctr Delft, Delft, Netherlands
[12] Med Spectrum Twente, Dept Gastroenterol & Hepatol, Enschede, Netherlands
关键词
Autoimmune hepatitis; Relapse; Remission; Medication; Drug withdrawal; Azathioprine; Steroids; ACTIVE LIVER-DISEASE; INFLAMMATORY-BOWEL-DISEASE; CORTICOSTEROID-THERAPY; PROGNOSIS; MANAGEMENT; FEATURES; MARKERS;
D O I
10.1016/j.jhep.2012.09.009
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Current treatment strategies in autoimmune hepatitis (AIH) include long-term treatment with corticosteroids and/or azathioprine. Here we determined the risk of relapse after drug withdrawal in patients in long-term remission and factors associated with such a relapse. Methods: A total of 131 patients (out of a cohort including 844 patients) from 7 academic and 14 regional centres in the Netherlands were identified in whom treatment was tapered after at least 2 years of clinical and biochemical remission. Relapse was defined as alanine-aminotransferase levels (ALT) three times above the upper limit of normal and loss of remission as a rising ALT necessitating the reinstitution of drug treatment. Results: During follow-up, 61 (47%) patients relapsed and 56 (42%) had a loss of remission. In these 117 patients, 60 patients had fully discontinued medication whereas 57 patients were still on a withdrawal scheme. One year after drug withdrawal, 59% of the patients required retreatment, increasing to 73% and 81% after 2 and 3 years, respectively. Previous combination therapy of corticosteroids and azathioprine, a concomitant autoimmune disease and younger age at time of drug withdrawal were associated with an increased risk of relapse. Subsequent attempts for discontinuation after initial failure in 32 patients inevitably resulted in a new relapse. Conclusions: This retrospective analysis indicates that loss of remission or relapse occurs in virtually all patients with AIH in long-term remission when immunosuppressive therapy is discontinued. These findings indicate a reluctant attitude towards discontinuation of immunosuppressive treatment in AIH patients. (C) 2012 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
引用
收藏
页码:141 / 147
页数:7
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