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Permanent drug withdrawal observed in patients with autoimmune hepatitis

Permanent drug withdrawal was an achievable treatment-free outcome and varied widely for patients with autoimmune hepatitis, according to a meta-analysis.

Researchers cited at least 50 studies in PubMed from 1972 to 2014 that focused on autoimmune hepatitis, treatment, relapse, remission and outcome. Earlier studies reported that a treatment-free state after drug withdrawal occurred for 4.5 years in 8% of patients; while later studies indicated that 40% of patients were treatment-free after drug withdrawal for 2 months to 3 years. Other data showed that 19% to 40% of patients were treatment-free for at least 3 years. In patients with inactive cirrhosis, just 9% were treatment-free after therapy for at least 3 months.

According to the analysis, patients aged 60 years or older improved to normal or near-normal liver tests and liver tissue within 6 months compared with adult patients aged younger than 40 years (18% vs. 2%), and the older patients also responded more favorably within 24 months (94% vs. 64%). In all, normal liver tissue was achieved by 22% of patients who underwent conventional corticosteroid therapy.

Early studies showed 41% of untreated patients become permanently inactive. Patients who induced laboratory resolution and normal or near-normal histological examinations before drug withdrawal was complete, lowered their chances of relapsing more than patients with mildly abnormal liver tests and liver tissue (32% vs. 9%).

Relapse after drug withdrawal occurred in 50% to 87% of patients and was associated with hepatic fibrosis. Patients who developed cirrhosis during therapy relapsed more often than other patients (OR=19.3; 95% CI, 2.2-40).

“The permanent elimination of the critical pathogenic mechanism that perpetuates autoimmune hepatitis may elude all therapies, and the success of each intervention in establishing a treatment-free state may depend on patient selection and the tenacity to treat modifiable pathogenic mechanisms to their full clinical resolution,” the researchers wrote. “The individual response to conventional corticosteroid treatment is the most reliable basis for refining treatment goals and strategies.”

Disclosure: The researchers report no relevant financial disclosures.