title: Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis.
abstract: OBJECTIVE
  In autoimmune hepatitis (AIH), relapse rates as high as 90% have been reported after treatment withdrawal. We therefore investigated, whether longer duration of treatment and proper patient selection could increase the long-term success rates after treatment withdrawal.
  
  
  METHODS
  Following our previously published experience, treatment withdrawal was considered when biochemical remission was maintained under immunosuppressive monotherapy for at least 2 years. Remission was defined as repeatedly normal serum aminotransferase levels as well as normal IgG levels.
  
  
  RESULTS
  Out of 288 patients with well-defined AIH, 28 patients were included. Median duration of treatment was 48.5 months (range 35-179) and a sustained remission was observed for 45 months (range 24-111). All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn. Using this strict approach, 15 patients (54%) remained in long-term remission after a median of 28 months follow-up (range 17-57) and 13 patients (46%) required reinstitution of treatment. Higher ALT and IgG levels - although within the normal range in all patients--were associated with the time to relapse. All patients who remained in remission had ALT levels less than half the ULN and IgG levels not higher than 12 g/L at the time of treatment withdrawal.
  
  
  CONCLUSIONS
  Proper patient selection including a sustained complete biochemical remission on immunosuppressive monotherapy for a minimum of 2 years can markedly improve the success rates of treatment withdrawal. The interpretation of aminotransferase and IgG levels within the normal range could aid in predicting the risk of relapse.
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hartl
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Ehlken
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Weiler-Normann
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Marcial
authors.initials: M
authors.lastname: Sebode
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany; Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Benno
authors.initials: B
authors.lastname: Kreuels
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Pannicke
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Zenouzi
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Glaubke
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany. Electronic address: cschramm@uke.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002648:Child; D005260:Female; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000410:Alanine Transaminase
keywords: Autoimmune hepatitis; Drug withdrawal; Immunosuppressive therapy; Loss of remission; Predictors for relapse; Relapse; Remission; Treatment duration