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[Immunosuppressive treatment of patients with chronic active HBsAg positive hepatitis]
Insights
Treatment with corticosteroids and azathioprine for chronic active hepatitis B (CAH-B) showed better outcomes in patients without cirrhosis. Cirrhosis at diagnosis significantly increases mortality risk in CAH-B patients.
Area of Science:
- Hepatology
- Immunosuppressive Therapy
- Viral Hepatitis
Context:
- Chronic active hepatitis B (CAH-B) is an inflammatory liver condition.
- Simultaneous treatment with corticosteroids and azathioprine is a therapeutic approach.
- Patient stratification based on cirrhosis presence is crucial for prognosis.
Purpose:
- To evaluate the efficacy and safety of combined corticosteroid and azathioprine therapy in CAH-B patients.
- To compare treatment outcomes between CAH-B patients with and without cirrhosis.
- To assess the role of ASAT levels and liver biopsy in monitoring treatment response.
Summary:
- Sixty-four CAH-B patients received corticosteroids and azathioprine for an average of 52 months, divided into groups with (19) and without (45) cirrhosis.
- Patients without cirrhosis had a 49% histology improvement and treatment discontinuation rate, with half experiencing relapse.
- The cirrhosis group had a 69% mortality rate, with all deaths occurring in patients unable to discontinue medication; ASAT levels proved a reliable activity marker.
Impact:
- Therapeutic response in CAH-B is significantly better in patients without cirrhosis at the start of treatment.
- Early cirrhosis in CAH-B patients is associated with a high mortality rate, underscoring the need for timely intervention.
- ASAT levels serve as a good indicator for monitoring disease activity and guiding treatment adjustments in CAH-B.
Abstract:
Sixty four CAH type B patients were studied, they were simultaneously treated with corticosteroids and azathioprine for an average period of 52 months. The patients were classified into two groups: CAH without cirrhosis (45) and CAH with cirrhosis (19). Patients were initially treated with doses of 40 mg prednisone and 50 mg azathioprine. The reduction of steroids was done according to ASAT level; medication being discontinued when there were not signs of activity in liver biopsy. Therapy was readministered due to elevation of ASAT (5 fold) and the liver biopsy shown pattern of CAH. 49% of CAH patients without cirrhosis improve histology and discontinue treatment; half of them had to resume therapy because of relapse. 14% of the patients died (4); three of them belonging to the group who continued taking the drugs. In the CAH group with cirrhosis, 6 were in remission and withdrawn-from treatment, but 5 had to resume it. The mortality rate of this group was of 69% (13), all patients belonging to the group where were not able to discontinue medication. In both groups ASAT was a good parameter of activity. Complications were more frequent in the group with cirrhosis (42%) than in the one without cirrhosis (17%) (p less than 0.01). In patients with CAH type B, the best therapeutic response was associated to those cases without cirrhosis. Mortality rate is high in patients with cirrhosis at onset of therapy.