Antibodies to liver-specific protein predict outcome of treatment withdrawal in autoimmune chronic active hepatitis

Abstract

The value of serum autoantibodies against the liver-specific membrane lipoprotein (LSP) complex in predicting the outcome of treatment withdrawal was assessed in 22 patients with autoimmune chronic active hepatitis who had been maintained in remission on azathioprine and/or prednisolone. At the start of treatment withdrawal 8 patients had anti-LSP antibodies. Within 7-20 weeks (median 12 weeks) all 8 showed biochemical (aminotransferase greater than 200 IU/l) amd histological (piecemeal necrosis) evidence of reactivation of disease. Of the remaining 14 patients, who did not have anti-LSP antibodies at the start of treatment withdrawal, 8 became seropositive within 2-13 weeks (median 6 weeks) and all 8 had relapsed by 21 weeks. In 7 of these eight, anti-LSP first appeared 3 to 10 weeks (median 6 weeks) before and, in the eighth, coincident with biochemical evidence of relapse. The remaining 6 patients continued to be anti-LSP negative and showed no evidence of reactivation of disease throughout the study period (median 29 weeks, range 26-32 weeks). The results show that the presence of anti-LSP antibodies in patients who are apparently in complete remission is invariably associated with reactivation of disease during treatment withdrawal.