Relapse rates in patients with autoimmune hepatitis after withdrawal of medication.

Autoimmune hepatitis is a chronic inflammatory disorder of the liver. The current work aimed to evaluate the time periods for relapse after withdrawal of immunosuppressive medication due to side effects or patient"s wish, in a real life setting. Also, predictive factors for outcome were evaluated. A total of 75 patients was investigated from January 2007 until July 2017 at Helios Universitätsklinikum Wuppertal. The clinical development after discontinuation or discontinuation of maintenance therapy was evaluated.

Overall, time period for evaluation of relapse rates after withdrawal ranged at 18 – 114 months. From the 75 treated patients who discontinued medication, 51 patients (68%) had a relapse after an average of 8.6 months, 24 patients (32%), however, maintained a remission without further medication. Out of 14 patients who received a monotherapy for conservation with azathioprine, 12 patients (85.71%) had a relapse after an average of 7,1 months. Only three out of 9 patients (33,33%) in the prednisolone mono-group presented a recurrence after an average of 9 months. Of the 23 patients treated with budesonide monotherapy patients, a total of 14 (60,9%) had relapse after an average of 11.9 months. 12 (75%) of 16 patients which maintenance therapy with azathioprine and prednisolone had a relapse after an average 4.6 months. From the group of patients with a combination therapy of azathioprine and budesonide relapsed 4/6 (66,67%) patients after ˜13.5 months. Of the two patients who received cyclosporine, both had a relapse after 11,5 months following discontinuation of therapy. Thus, the risk of relapse was 0.2 times lower for those treated with budesonide compared to the group treated with azathioprin (p = 0,01). The combination of azathioprin and budesonide seems to provide a 0,204-times lower Risk to agonize/gain a relapse as when using only azathioprin (p-value = 0,030).

Withdrawal of immunosuppressive medication is associated with approximately 60% risk of relapse in AIH. The highest risk for relapse was found in the group treated with azathioprine monotherapy, while prednisolone treatment over more than 3 years led to a lower relapse rate. Therefore, the combination-therapy of azathioprine/prednisolon or azathioprine/budesonide as well as monotherapy with prednisolon compared to azathioprine monotherapy was shown to be superior with regard to the appearance of relapse.