Atsushi Takahashi1, Hiromasa Ohira1, Kazumichi Abe1, Yasuhiro Miyake2, Masanori Abe3, Kazuhide Yamamoto2, Yoshiyuki Suzuki4, Morikazu Onji3, Hirohito Tsubouchi5. 1. Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan. 2. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 3. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan. 4. Department of Hepatology, Toranomon Hospital, Tokyo, Japan. 5. Kagoshima City Hospital, Kagoshima, Japan.
Abstract
AIM: Patients with autoimmune hepatitis (AIH) sometimes relapse after immunosuppressive therapies are discontinued or sometimes even while they are still being administrated. Furthermore, relapse often occurs in the absence of AIH relapse risk factors. This study aimed to identify the frequency of relapse and to analyze the risk factors associated with relapse in type 1 AIH patients. METHODS: Clinical characteristics and therapeutic processes were assessed in 129 type 1 AIH patients. RESULTS: Relapse was identified in 39 (30.2%) type 1 AIH patients after alanine aminotransferase (ALT) level normalization. ALT levels significantly increased when corticosteroid treatment was initiated in relapsed patients compared with that in patients with sustained remission. The reduction dose and rate of corticosteroid taper were significantly increased in relapsed patients compared with those in sustained remission patients. Moreover, positive correlations were identified between the reduction dose/taper rate and initial corticosteroid dose, and ALT levels, total bilirubin levels and hepatitis activity. Multivariate logistic regression analysis identified the corticosteroid reduction rate as significantly associated with AIH relapse. CONCLUSION: Corticosteroid reduction taper rate until ALT normalization is an important AIH relapse risk factor.
AIM: Patients with autoimmune hepatitis (AIH) sometimes relapse after immunosuppressive therapies are discontinued or sometimes even while they are still being administrated. Furthermore, relapse often occurs in the absence of AIH relapse risk factors. This study aimed to identify the frequency of relapse and to analyze the risk factors associated with relapse in type 1 AIH patients. METHODS: Clinical characteristics and therapeutic processes were assessed in 129 type 1 AIH patients. RESULTS: Relapse was identified in 39 (30.2%) type 1 AIH patients after alanine aminotransferase (ALT) level normalization. ALT levels significantly increased when corticosteroid treatment was initiated in relapsed patients compared with that in patients with sustained remission. The reduction dose and rate of corticosteroid taper were significantly increased in relapsed patients compared with those in sustained remission patients. Moreover, positive correlations were identified between the reduction dose/taper rate and initial corticosteroid dose, and ALT levels, total bilirubin levels and hepatitis activity. Multivariate logistic regression analysis identified the corticosteroid reduction rate as significantly associated with AIH relapse. CONCLUSION: Corticosteroid reduction taper rate until ALT normalization is an important AIH relapse risk factor.