Rapidity of treatment response and outcome in type 1 autoimmune hepatitis

Abstract

Background/aims: Corticosteroid therapy is effective in type 1 autoimmune hepatitis. This study determines if the rapidity of response affects outcome.

Methods: The duration of treatment to improve clinical and laboratory indices was determined retrospectively in 146 patients and correlated with outcome.

Results: Sixteen patients (11%) responded after < or =6 months, and 20 patients did so after 36 months (14%). The rapid responders were older than those who responded slowly (54+/-3 years versus 41+/-4 years, P=0.007), and they had a lower frequency of HLA DRB1 *03 (36% versus 76%, P=0.03). Patients aged > or =60 years responded within 6 months more commonly than adults aged <40 years (18% versus 2%, P=0.02), and most had responded within 24 months (94% versus 64%, P=0.003). Elderly patients who responded quickly had HLA DRB1 *04 more commonly than adults aged <40 years (75% versus 8%, P=0.0001). Progression to cirrhosis (18% versus 54%, P=0.03) and liver transplantation (2% versus 15%, P<0.05) was less common in the rapid responders. The frequencies of a sustained remission (19% versus 10%, P=0.6) and relapse after drug withdrawal (81% versus 90%, P=0.6) were similar between patients with an early and late response.

Conclusions: A rapid treatment response decreases progression to cirrhosis and liver transplantation, but it does not alter the frequency of sustained remission or relapse after drug withdrawal. Elderly patients respond more quickly to treatment than adults aged <40 years, and they are characterized by HLA DRB1 *04.