Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis.
OBJECTIVE
This study aimed to investigate the efficacy of ursodeoxycholic acid (UDCA) for Japanese patients with autoimmune hepatitis (AIH).


METHODS
One hundred forty-seven patients were investigated.


RESULTS
As initial treatment, 25 patients received UDCA (300-600 mg/day) monotherapy (UDCA group), 40 received a combination of prednisolone (PSL) (≥20 mg/day) and UDCA (combination group), 68 received PSL monotherapy (PSL group), and 14 received other treatments. During the follow-up, in the UDCA group, PSL was added to 8 of 12 patients failing to achieve the normalization of serum transaminase levels with UDCA monotherapy. Cumulative incidence of the normalization of serum transaminase levels was 64% in the UDCA group, 95% in the combination group, and 94% in the PSL group (log-rank test, P = 0.0001). UDCA group required longest periods until the normalization of serum transaminase levels. Eleven patients, who achieved persistent normalization of serum transaminase levels with UDCA monotherapy, did not reach liver failure or develop hepatocellular carcinoma for 49.7 (range = 13.4-137.3) months. Meanwhile, during the taper of PSL, doses of PSL at the initial relapse were lower in patients treated with PSL and UDCA than in those treated with PSL monotherapy, and initial relapse occurred earlier in patients treated with PSL monotherapy.


CONCLUSIONS
UDCA monotherapy is effective for some Japanese AIH patients; however, UDCA monotherapy for patients with either high-grade inflammatory activity or poor residual capacity of liver function is not recommended because they may reach liver failure before achievement of remission. Meanwhile, additional use of UDCA during the taper of corticosteroids may be effective for the prevention of early relapse.
Yasuhiro
Y
Miyake
Yoshiaki
Y
Iwasaki
Haruhiko
H
Kobashi
Tetsuya
T
Yasunaka
Fusao
F
Ikeda
Akinobu
A
Takaki
Ryoichi
R
Okamoto
Kouichi
K
Takaguchi
Hiroshi
H
Ikeda
Yasuhiro
Y
Makino
Masaharu
M
Ando
Kohsaku
K
Sakaguchi
Kazuhide
K
Yamamoto