Low-dose corticosteroid therapy after multiple relapses of severe HBsAg-negative chronic active hepatitis.
To evaluate the efficacy of low-dose corticosteroid therapy after multiple relapses of severe HBsAg-negative chronic active hepatitis, 22 patients who had relapsed on 3.4 +/- 0.4 occasions (range = two to seven relapses) were treated with the lowest dose of medication necessary to ameliorate symptoms and maintain serum AST activity below five-fold normal. Results were compared with those in 31 patients who had received conventional retreatments after 3.4 +/- 0.3 relapses (range = two to eight relapses). During 44 +/- 7 mo of low-dose therapy (range = 9 to 149 mo), one patient (5%) entered sustained remission, 16 patients (72%) continued treatment, two patients (9%) received liver transplantations, two patients (9%) died of liver-related complications and one patient (5%) died of a nonliver-related cause. Drug-related side effects improved in 11 of 13 patients who had acquired them during conventional therapy (85%). The median dose of prednisone was 7.5 mg daily (range = 1 to 17.5 mg) with and without azathioprine. Thirteen patients received long-term treatment consisting of 10 mg or less of prednisone only. Patients receiving conventional treatment entered remission more frequently than those on low-dose therapy (97% vs. 36%, p less than 0.001) but they relapsed after drug withdrawal (53% vs. 87%, p greater than 0.01), required continuous therapy (55% vs. 72%, p greater than 0.1) and died of liver-related complications (10% vs. 9%) as commonly as those receiving low-dose therapy. We conclude that low-dose corticosteroid therapy in patients who have experienced multiple relapses has similar efficacy and less morbidity than conventional retreatments.
Czaja
A J
AJ
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905.
D001379:Azathioprine / Q000627:therapeutic use; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D006505:Hepatitis / Q000188:drug therapy* / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006801:Humans; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction
D004338:Drug Combinations; D006514:Hepatitis B Surface Antigens; D001379:Azathioprine; D011241:Prednisone