Controlled Prospective Trial of Corticosteroid Therapy in Active Chronic Hepatitis

Cook, Gordon; Mulligan, Rosemary; Sherlock, Sheila

doi:10.1093/oxfordjournals.qjmed.a067264

Cited by 510 publications

(255 citation statements)

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“…[2][3][4][5][6][7] Although steroids have greatly improved the survival of patients with AIH, whether they prevent fibrosis and ultimate progression to cirrhosis is unclear. In addition, corticosteroid therapy is associated with numerous significant toxicities.…”

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confidence: 99%

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

et al. 2005

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Although the natural history of autoimmune hepatitis (AIH) has been characterized, little is known about patients who present asymptomatically. Consequently, whether they require immunosuppressive therapy with its associated complications is unclear. To compare the natural history of asymptomatic AIH with symptomatic AIH, a large cohort of patients from a single center was examined. All patients with a clinical diagnosis of AIH were reassessed using the revised criteria of the International Autoimmune Hepatitis Group. Liver histology, response to therapy, and survival were assessed. Patients asymptomatic at presentation (n ‫؍‬ 31) had lower serum aminotransferase, bilirubin, and immunoglobulin G (IgG) values at baseline. Half of the asymptomatic patients received no therapy, and their survival was no different from that of the total cohort. Ten-year survival was 80.0% (62.5%-97.5%) in the asymptomatic group and 83.8% (75.1%-92.6%) in the symptomatic patients (P ‫؍‬ NS). Survival to liver-related endpoints at 10 years was similar in both groups: 89.5% (

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confidence: 99%

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

et al. 2005

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“…However, conventional trials with randomly allocated non-treated controls were still called for, and these convincingly indicated survival benefits for the treated patients. The study of Cook et al [35] is exemplary, albeit with a substantial burden of mortality among the control group (Figure 2). Detailed studies on immunosuppressive therapy by the Mayo Clinic through the 1970s-1980s, with substantial case numbers, have shown sustained efficacy according to various criteria, survival, biochemical and histological [36] .…”

Section: Therapies For Chronic Active/aihmentioning

confidence: 97%

Historical reflections on autoimmune hepatitis

Mackay

2008

WJG

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Autoimmune hepatitis (AIH), initially known as chronic active or active chronic hepatitis (and by various other names), first came under clinical notice in the late 1940s. However, quite likely, chronic active hepatitis (CAH) had been observed prior to this and was attributed to a persistently destructive virus infection of the liver. An earlier (and controversial) designation in 1956 as lupoid hepatitis was derived from associated L.E. cell test positivity and emphasized accompanying multisystem features and immunological aberrations. Yo u n g w o m e n f e a t u r e d p r o m i n e n t l y i n e a r l y descriptions of CAH. AIH was first applied in 1965 as a descriptive term. Disease-characteristic autoantibodies were defined from the early 1960s, notably antinuclear antibody (ANA), smooth muscle antibody (SMA) and liver-kidney microsomal (LKM) antibody. These are still widely used diagnostically but their relationship to pathogenesis is still not evident. A liver and disease specific autoantigen has long been searched for but unsuccessfully. Prolonged immunosuppressive therapy with prednisolone and azathioprine in the 1960s proved beneficial and remains standard therapy today. AIH like many other autoimmune diseases is associated with particular HLA alleles especially with the "ancestral" B8, DR3 haplotype, and also with DR4. Looking forwards, AIH is one of the several enigmatic autoimmune diseases that, despite being (relatively) organ specific, are marked by autoimmune reactivities with non-organ-specific autoantigens. New paradigms are needed to explain the occurrence, expressions and pathogenesis of such diseases.

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“…Autoimmune hepatitis (AIH) is a chronic progressive autoimmune liver disease with unknown etiology, characterized by hyperimmunoglobulinemia, the presence of autoantibodies in serum, interface hepatitis on liver histology [3]. The biochemical features include elevated transaminases and IgG levels, which are the principal indicators of immunosuppressive therapies [4,5]. In general, AIH patients have good responses to immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%