title: Efficacy of intravenous glycyrrhizin in the early stage of acute onset autoimmune hepatitis.
abstract: BACKGROUND
  Acute onset autoimmune hepatitis (AIH) shows acute presentation like acute hepatitis and does not have typical clinicopathological features of AIH. There is no gold standard for making the diagnosis. Therefore, losing the timing of starting immunosuppressive therapy, some of the cases develop into severe or fulminant form and have poor prognosis.
  
  
  OBJECTIVE
  Our aim was to elucidate the efficacy of intravenous glycyrrhizin in decreasing alanine aminotransferase (ALT) level in the early stage of acute onset AIH.
  
  
  METHODS
  Thirty-one patients were defined as acute onset AIH based on our uniform criteria, and were enrolled in this study. We prospectively treated 17 patients with sufficient doses (100 ml/day) of intravenous glycyrrhizin (SNMC) at an early stage (SNMC group), and treated 14 patients of severe disease with intravenous glycyrrhizin and corticosteroids (CS) (SNMC + CS group). We examined their clinical and biochemical features and treatment responses.
  
  
  RESULTS
  The ALT level could be controlled at an early stage using SNMC with no significant difference compared with SNMC + CS, and responsiveness to the therapy was determined by the disease severity at the time of starting therapy rather than the time duration from onset to therapy. Recovery rate was higher in the SNMC group than in the SNMC + CS group (P = 0.035).
  
  
  CONCLUSIONS
  The early introduction of sufficient doses of SNMC might prevent disease progression in patients with acute onset AIH. SNMC can be used safely and be useful for patients with difficult-to-diagnose acute liver disease as an 'initial' treatment tool to improve liver inflammation before starting disease-specific treatments.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yasui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Akinobu
authors.initials: A
authors.lastname: Tawada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D019695:Glycyrrhizic Acid / Q000008:administration & dosage*; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D019695:Glycyrrhizic Acid