Complete Resolution of Inflammatory Activity Following Corticosteroid Treatment of HBsAg-Negative Chronic Active Hepatitis

Authors

  • Albert J. Czaja,

    Corresponding author
    1. Departments of Medicine, Pathology, and Laboratory Medicine, Mayo Clinic and Medical School, Rochester, Minnesota 55905
    • Albert J. Czaja, M.D., Mayo Clinic, Rochester, Minnesota 55905.
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  • Gary L. Davis,

    1. Departments of Medicine, Pathology, and Laboratory Medicine, Mayo Clinic and Medical School, Rochester, Minnesota 55905
    Current affiliation:
    1. University of Florida College of Medicine, Gainesville, Florida 32610.
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  • Jurgen Ludwig,

    1. Departments of Medicine, Pathology, and Laboratory Medicine, Mayo Clinic and Medical School, Rochester, Minnesota 55905
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  • Howard F. Taswell

    1. Departments of Medicine, Pathology, and Laboratory Medicine, Mayo Clinic and Medical School, Rochester, Minnesota 55905
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  • This work was presented in part at the Plenary Session of the meeting of the American Association for the Study of Liver Diseases, November 7, 1981, Chicago, Illinois

Abstract

To assess the frequency and significance of complete resolution of inflammatory activity following corticosteroid therapy, 115 patients with severe HBsAg-negative chronic active hepatitis were followed regularly for 84 ± 5 months. Of 83 patients eligible to revert to normal liver tissue, 18 did so after 56 ± 8 months. Five of the 18 relapsed after treatment withdrawal. Only patients who improved spontaneously after cessation of treatment from histologic features of chronic persistent hepatitis to normal invariably sustained the improvement. Of 32 patients with cirrhosis at presentation, 17 reverted to inactive cirrhosis after 48 ± 10 months, but only 3 remained inactive after discontinuation of treatment. Mortality was similar in patients with and without reversion to normal tissue (0 vs. 14%, p ± 0.2), but the frequency of relapse was less after complete resolution (28 vs. 76%, p < 0.001). Reversion to inactive cirrhosis did not improve survival or reduce relapse frequency after remission and treatment withdrawal. Findings prior to therapy did not predict outcome. We conclude that complete resolution of inflammatory activity is possible, but that it occurs slowly, infrequently and unpredictably after therapy. In patients without cirrhosis, reversion to normal liver tissue decreases the likelihood of relapse and the requirement for retreatment. In patients with cirrhosis at presentation, elimination of inflammatory activity is rarely sustained and does not improve prognosis after remission and treatment withdrawal.

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