Consequences of treatment withdrawal in type 1 autoimmune hepatitis

Montano‐Loza, Aldo J.; Carpenter, Herschel A.; Czaja, Albert J.

doi:10.1111/j.1478-3231.2007.01444.x

Cited by 106 publications

(131 citation statements)

References 51 publications

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“…An important finding in our study was that decreasing AST/ALT levels to less than 30 IU/L for men and less than 19 IU/L for women (instead of reducing AST/ALT levels to less than twice the normal value reported by the laboratory) lessened the risk of relapse. Other investigators have also reported this phenomenon (18,26). Long-term continuation of maintenance therapy for those in remission can also prevent relapse (18,26).…”

Section: Discussionmentioning

confidence: 90%

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

et al. 2012

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Article type: Original ArticleBackground: There is limited data on the natural history of autoimmune hepatitis (AIH) and on the long-term follow-up of AIH patients who have been referred for regular medical attention. Objectives: We evaluated the clinical presentation and natural history of AIH in a large cohort of type I AIH patients from Iran. Patients and Methods: Between 1997 and 2008, 102 patients were enrolled in the study. Patients were diagnosed using the International Autoimmune Hepatitis Group criteria and were followed up for an average of 60 months. Clinical and biochemical data were gathered from all the patients at both the beginning and the end of the follow-up period. Liver biopsy was performed in all patients before treatment, and the biopsies were performed in 28 patients after treatment. Results: Biochemical remission was achieved by 80 (79.4%) patients. Of these, 53 (66.5%) showed near-normal liver histology or liver function test results and sonogram. The remaining 27 (33.5%) patients also achieved clinical and biochemical remission, but developed compensated cirrhosis. After a period of remission, 24 patients (32.5%) relapsed. Among the 22 (21.6%) patients who showed ultimate treatment failure, 6 underwent orthotopic liver transplantation and 3 died of liver failure while awaiting a transplant. Sixteen (72.7%) of the 22 patients who did not respond to therapy were non-compliant with medications and had irregular follow-up. The overall 10-year survival rate in the cohort was 96%. Conclusions: Long-term survival in AIH patients is very good. Prompt diagnosis and appropriate first-line and salvage therapy that includes close follow-up will make liver transplantation a rare necessity in the treatment of this disease.

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Section: Discussionmentioning

confidence: 90%

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

et al. 2012

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“…100 However, while surrogate outcomes have some utility in signaling the presence of inflammatory disease, it has become increasingly less clear the extent to which changing a marker associated with disease alters the course of the disease itself; 'few surrogate markers' have been shown to 'capture the effect of a treatment'. 101 More and more researchers and physicians routinely deprecate evidence devoid of outcomes that matter most to patients and their caregivers (i.e., patient-important outcomes).…”

Section: Surrogate Outcomes For Disease Must Be Carefully Chosenmentioning

confidence: 99%

Immunostimulation in the era of the metagenome

Proal

Albert

Blaney³

et al. 2011

Cell Mol Immunol

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Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.

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“…Remission is achievable in around 75-80% of patients after 24 months of treatment (including those with cirrhosis) and associated with around 80% patient survival at 10 years [Montano-Loza et al 2007a;Johnson et al 1995]. Normalization of serum aminotransferase levels within 3 months of starting therapy is highly predictive for sustained biochemical remission at 2 years [Wang et al 2011].…”

Section: Maintaining Remissionmentioning

confidence: 99%

Treatment of autoimmune liver disease: current and future therapeutic options

Trivedi

Hirschfield

2013

Therapeutic Advances in Chronic Disease

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Autoimmune liver disease spans three predominant processes, from the interface hepatitis of autoimmune hepatitis to the lymphocytic cholangitis of primary biliary cirrhosis, and finally the obstructive fibrosing sclerotic cholangiopathy of primary sclerosing cholangitis. Although all autoimmune in origin, they differ in their epidemiology, presentation and response to immunosuppressive therapy and bile acid based treatments. With an ongoing better appreciation of disease aetiology and pathogenesis, treatment is set ultimately to become more rational. We provide an overview of current and future therapies for patients with autoimmune liver disease, with an emphasis placed on some of the evidence that drives current practice.

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Consequences of treatment withdrawal in type 1 autoimmune hepatitis

Abstract: Multiple relapses are associated with a poorer prognosis than sustained remission or single relapse episodes. Initial treatment to resolution of laboratory abnormalities may afford the greatest opportunity to prevent relapse.

Cited by 106 publications

References 51 publications

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

Immunostimulation in the era of the metagenome

Treatment of autoimmune liver disease: current and future therapeutic options

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