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Impact of Immunosuppressive Treatment on Liver Fibrosis in Autoimmune Hepatitis

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Abstract

The impact of treatment on progression of fibrosis in autoimmune hepatitis (AIH) is unknown. We assessed the changes in liver fibrosis before and after treatment among these patients. Nineteen AIH patients who had paired liver biopsies were studied. Of these, seven had been treated with 6 months of cyclosporine A and the rest with 6 months of prednisolone for induction of remission. Thereafter all had been maintained on azathioprine. Biopsy specimens before and after treatment were reviewed by one pathologist and scored by the Ishak method. Mean fibrosis stages before and after treatment were compared. Also, factors predicting significant fibrosis (stage ≥3) and cirrhosis (stage ≥5) at presentation were assessed. Mean interval between biopsies was 3.38 years. Mean fibrosis stage decreased from 4.53 to 2.16 following treatment (P < 0.001). Mean decrement in inflammatory grade was 8 scores (range, 4–10) in patients in whom fibrosis improved, and 2 scores (range, 0–4) in patients in whom fibrosis did not decrease after treatment (P < 0.001). ALT-to-platelet ratio was the best predictor of significant fibrosis and also cirrhosis. Fibrosis commonly improves after immunosuppressive treatment in AIH. ALT-to-platelet ratio can predict accurately the presence of significant fibrosis and cirrhosis in AIH.

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References

  1. Poynard T, McHutchison J, Davis GL, Esteban-Mur R, Goodman Z, Bedossa P, Albrecht J: Impact of interferon alfa-2b and ribavirin on progression of liver fibrosis in patients with chronic hepatitis C. Hepatology 32:1131–1137, 2000

    Google Scholar 

  2. Hammel P, Couvelard A, O’Toole D, Ratouis A, Sauvanet A, Flejou JF, Degott C, Belghiti J, Bernades P, Valla D, Ruszniewski P, Levy P: Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. N Engl J Med 344:418–423, 2001

    Google Scholar 

  3. Czaja AJ, Carpenter HA: Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis. J Hepatol 40:646–652, 2004

    Google Scholar 

  4. Dufour JF, DeLellis R, Kaplan MM: Reversibility of hepatic fibrosis in autoimmune hepatitis. Ann Intern Med 127:981–985, 1997

    Google Scholar 

  5. Cotler SJ, Jakate S, Jensen DM: Resolution of cirrhosis in autoimmune hepatitis with corticosteroid therapy. J Clin Gastroenterol 32:428–430, 2001

    Google Scholar 

  6. Malekzadeh R, Nasseri-Moghaddam S, Kaviani MJ, Taheri H, Kamalian N, Sotoudeh M: Cyclosporin A is a promising alternative to corticosteroids in autoimmune hepatitis. Dig Dis Sci 46:1321–1327, 2001

    Google Scholar 

  7. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, Phillips MJ, Portmann BG, Poulsen H, Scheuer PJ, Schmid M, Thaler H: Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699, 1995

    Article  CAS  PubMed  Google Scholar 

  8. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS: A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38:518–526, 2003

    Google Scholar 

  9. Czaja AJ: Autoimmune hepatitis. In Gastrointestinal and Liver Disease, 7th ed. Feldman M, Friedman LS, Sleizenger MH (eds). Philadelphia, Saunders, 2002, pp 1462–1473

    Google Scholar 

  10. Marzano A, Trapani A, Leone N, Actis GC, Rizzetto M: Treatment of idiopathic retroperitoneal fibrosis using cyclosporine A. Ann Rheum Dis 60:427–428, 2001

    Google Scholar 

  11. Filaci G, Cutolo M, Basso M, Murdaca G, Derchi L, Gianrossi R, Ropolo F, Zentilin P, Sulli A, Puppo F, Indiveri F: Long-term treatment of patients affected by systemic sclerosis with cyclosporin A. Rheumatology (Oxford) 40:1431–1432, 2001

    Google Scholar 

  12. Rosenberg WM: Rating fibrosis progression in chronic liver diseases. J Hepatol 38: 357–360, 2003

    Google Scholar 

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Authors and Affiliations

  1. Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran

    Mehdi Mohamadnejad MD

  2. Digestive Disease Research Center, Tehran, Iran

    Mehdi Mohamadnejad MD, Reza Malekzadeh MD, Siavosh Nasseri-Moghaddam MD, Sepideh Hagh-Azali MD, Nasser Rakhshani MD, Seyed Mohamad Tavangar MD & Seyed Meysam Alimohamadi

  3. Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Mojtaba Sedaghat MD

  4. Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran, 14114, Iran

    Reza Malekzadeh MD

Authors
  1. Mehdi Mohamadnejad MD
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  2. Reza Malekzadeh MD
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  3. Siavosh Nasseri-Moghaddam MD
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  4. Sepideh Hagh-Azali MD
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  5. Nasser Rakhshani MD
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  6. Seyed Mohamad Tavangar MD
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  7. Mojtaba Sedaghat MD
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  8. Seyed Meysam Alimohamadi
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Corresponding author

Correspondence to Reza Malekzadeh MD.

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Mohamadnejad, M., Malekzadeh, R., Nasseri-Moghaddam, S. et al. Impact of Immunosuppressive Treatment on Liver Fibrosis in Autoimmune Hepatitis. Dig Dis Sci 50, 547–551 (2005). https://doi.org/10.1007/s10620-005-2472-5

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  • DOI: https://doi.org/10.1007/s10620-005-2472-5

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