[Type 1 autoimmune hepatitis in children and adolescents: assessment of immunosuppressive treatment withdrawal].
OBJECTIVE
To assess treatment withdrawal in children and adolescents with autoimmune hepatitis, with clinical and laboratory remission for a minimum period of 24 months, determining the relapse rate after treatment withdrawal.


METHODS
This is a descriptive, retrospective and partially prospective study of 21 children and adolescents with type 1 autoimmune hepatitis treated at the Outpatient Division of Pediatric Hepatology, Teaching Hospital of Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil, between January 1986 and December 2001.


RESULTS
We assessed 54 patients and selected 21, of whom 19 were female subjects (90.5%), aged between 5.7 and 17.6 years (median = 13.8 years), with a mean follow-up of 5.1+/-2.4 years (median = 4.4 years) and an average clinical and laboratory remission of 4.1+/-1.5 years (median = 4.1 years). Out of the 21 patients studied, 10 (47.6%) manifested some inflammatory activity that prevented the discontinuation of treatment, which was withdrawn in 11 patients (52.4%). Out of these, six patients (54.5%) presented reactivation of the disease and five maintained clinical and laboratory remission with a mean follow-up of 4+/-1 years (median = 3.9 years). The time interval between discontinuation of treatment and reactivation of the disease ranged from 29 days to 40.3 months (median = 2.2 months).


CONCLUSIONS
We observed a high relapse rate (54.5%) in this group of patients with autoimmune hepatitis, which was more frequent within the first 12 months after treatment withdrawal, in addition to a high number of patients that presented some degree of inflammatory activity despite the long period of clinical and laboratory remission.
Ferreira
Alexandre R
AR
Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. alexfer@uai.com.br
Roquete
Mariza Leitão Valadares
ML
Penna
Francisco J
FJ
Toppa
Nivaldo H
NH
Castro
Lúcia Porto Fonseca de
LP
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008099:Liver / Q000473:pathology*; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D028761:Withholding Treatment
D007166:Immunosuppressive Agents