Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis

J Hepatol. 2015 Mar;62(3):642-6. doi: 10.1016/j.jhep.2014.10.018. Epub 2014 Oct 18.


Background & aims: 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 All patients were in remission on immunosuppressive monotherapy for a minimum of 2 years before treatment was withdrawn.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.

Keywords: Autoimmune hepatitis; Drug withdrawal; Immunosuppressive therapy; Loss of remission; Predictors for relapse; Relapse; Remission; Treatment duration.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alanine Transaminase / blood
  • Child
  • Female
  • Hepatitis, Autoimmune / blood
  • Hepatitis, Autoimmune / drug therapy*
  • Hepatitis, Autoimmune / immunology
  • Humans
  • Immunoglobulin G / blood
  • Immunosuppressive Agents / administration & dosage*
  • Liver / metabolism
  • Male
  • Middle Aged
  • Patient Selection*
  • Recurrence
  • Remission Induction
  • Time Factors
  • Withholding Treatment
  • Young Adult


  • Immunoglobulin G
  • Immunosuppressive Agents
  • Alanine Transaminase