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Long-term treatment reduction and steroids withdrawal in children with autoimmune hepatitis: a single centre

Jérôme Dumortier1, Carlos Torres Arita, Christine Rivet

  • 1Fédération des Spécialités Digestives bUnité d'Hépatologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. jerome.dumortier@chu-lyon.fr

European Journal of Gastroenterology & Hepatology
|November 13, 2009
PubMed

Insights

Long-term corticosteroid withdrawal is achievable in most children with autoimmune hepatitis (AIH). This study shows successful dose reduction and discontinuation of steroids in a large pediatric cohort, offering hope for improved treatment outcomes.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Immunology

Background:

  • Autoimmune hepatitis (AIH) in children is typically managed with corticosteroids and azathioprine.
  • Long-term corticosteroid use in pediatric AIH presents challenges regarding dose reduction and withdrawal.
  • This study evaluates the feasibility of reducing and withdrawing corticosteroids in a large cohort of children with AIH.

Purpose of the Study:

  • To describe the experience of long-term corticosteroid dose reduction and withdrawal in pediatric autoimmune hepatitis.
  • To assess the rate of successful corticosteroid withdrawal in children with AIH.
  • To evaluate treatment outcomes and maintenance therapy in this cohort.

Main Methods:

  • Retrospective analysis of pediatric patients diagnosed with AIH between 1990 and 2006.
  • Inclusion of all children presenting with AIH at the institution.
  • Review of treatment regimens, including corticosteroid and azathioprine use, and patient outcomes.

Main Results:

  • The cohort comprised 55 children with type 1, type 2, or seronegative AIH.
  • Complete remission was achieved in 69% of patients within 1 year.
  • Progressive corticosteroid dose reduction was implemented, with withdrawal possible in 90% of patients by 10 years; azathioprine was maintained in 80%.

Conclusions:

  • Long-term corticosteroid withdrawal is feasible in a significant majority of children diagnosed with autoimmune hepatitis.
  • These findings support the potential for optimizing treatment strategies to minimize steroid exposure in pediatric AIH.
  • Successful management involves careful dose titration and consideration of maintenance immunosuppression.
Abstract

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