Is there any predictor for relapse after treatment withdrawal in autoimmune hepatitis patients in the real life?

Bilger Çavuş, Filiz Akyuz, Raim İliaz, Alp Atasoy, Umit Akyuz, Kadir Demir, Fatih Besisik, Sabahattin Kaymakoglu
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引用次数: 1

Abstract

Backgrounds and aims: In autoimmune hepatitis, there are uncertainties about whether to discontinue the treatment, when the treatment should be discontinued, and the risks of relapse in the cases where remission is achieved with immunosuppressive therapy. In this study, patients with AIH, whose immunosuppressive treatments were discontinued, were evaluated for the rates of remission and the risk of relapse.

Materials and methods: A total of 119 patients, who were diagnosed with AIH based on the AIHG scoring systems between 1990 and 2015, were evaluated. Patients were receiving standard azathioprine and steroid therapy. The treatment was discontinued in patients, who had been receiving treatment for at least 2 years, who had no clinical complaints, and whose aminotransferases were normal and when an increase occurred in AST values more than two times the normal after the treatment was interrupted, the case was considered as a relapse.

Results: Among the patients, 83%(n = 99) were women. When the patients were diagnosed with AIH, their mean age was 36 ± 16(8-79) years; 70.6%(n = 84) were type 1, 3.4%(n = 4) type 2, and 26%(n = 31) were autoantibody-negative AIH. At the time of discontinuation, liver biopsy was performed in 8 of the patients and minimal-mild abnormalities were detected. Patients whose treatment was discontinued received treatment for an average of 101 ± 75(range: 24-280, median: 68.5) months; and, they were followed up for an average of 19 (1-110) months during the period without medication. Relapse occurred in 67%(n = 12) of the patients with drug withdrawal. Relapse occurred within the first 12 months in 67% of these patients (n = 8) and developed with an acute hepatitis attack in 42%. None of the clinical, laboratory, and histological data were found to be effective on relapse.

Conclusion: In patients with AIH, relapse occurs in two-thirds of patients within an average of 19 month after the discontinuation of the medication. Most relapses occur at the early period and they are accompanied by an acute hepatitis attack.

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现实生活中自身免疫性肝炎患者停药后是否有复发的预测因子?
背景和目的:在自身免疫性肝炎中,是否应该停止治疗,何时应该停止治疗,以及在免疫抑制治疗获得缓解的情况下复发的风险存在不确定性。在这项研究中,对停止免疫抑制治疗的AIH患者的缓解率和复发风险进行了评估。材料与方法:对1990 - 2015年间根据AIHG评分系统诊断为AIH的119例患者进行评估。患者接受标准硫唑嘌呤和类固醇治疗。治疗至少2年,无临床主诉,转氨酶正常,停药后AST升高超过正常2倍者,视为复发。结果:患者中女性占83%(n = 99)。确诊为AIH时,患者平均年龄36±16(8-79)岁;70.6%(n = 84)为1型,3.4%(n = 4)为2型,26%(n = 31)为自身抗体阴性AIH。在停药时,8例患者进行了肝活检,发现了轻微的异常。停止治疗的患者接受治疗的平均时间为101±75个月(范围:24-280,中位数:68.5);在不给药期间,平均随访19个月(1 ~ 110个月)。停药后复发的患者占67%(n = 12)。67%的患者(n = 8)在前12个月内复发,42%的患者出现急性肝炎发作。临床、实验室和组织学资料均未发现对复发有效。结论:在AIH患者中,三分之二的患者在停药后平均19个月内复发。大多数复发发生在早期,并伴有急性肝炎发作。
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来源期刊
CiteScore
4.00
自引率
0.00%
发文量
88
审稿时长
15 weeks
期刊介绍: International Journal of Immunopathology and Pharmacology is an Open Access peer-reviewed journal publishing original papers describing research in the fields of immunology, pathology and pharmacology. The intention is that the journal should reflect both the experimental and clinical aspects of immunology as well as advances in the understanding of the pathology and pharmacology of the immune system.
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