Drug withdrawal in patients with autoimmune hepatitis in long-term histological remission: A prospective observational study

BackgroundRecommendations for drug withdrawal in patients with autoimmune hepatitis (AIH) longstanding remission are conflicting and rely on retrospective data. We prospectively investigated the predictive value of histological normalisation successful treatment AIH patients.MethodsNon-cirrhotic established complete biochemical (normalisation serum alanine aminotransferase [ALT] or aspartate [AST] immunoglobulin G [IgG]) at least 2 years were biopsied. Immunosuppressive therapy was only withdrawn (histological activity index [HAI] ≤3) a minimum follow-up 12 months.ResultsA total 17 included. Persistent inflammatory (HAI >3) precluded five patients. These had higher values ALT (25 vs. 16 U/L; p = 0.01) AST (26 22 compared remission. medication patients; eight (67%, C.I. 40-93% 0.4) remained during median 62 months (range: 13-75 months); four (33%, 7-60% required reinstitution after 1, 6, 11, 40 months, all without clinical signs disease progression hepatic decompensation. No predictors relapse identified.ConclusionTwo-thirds who prove to have achieve treatment-free Although patient numbers small results should be interpreted caution, these findings support liver biopsy prior withdrawal.