STEROID-THERAPY OF CHRONIC HEPATITIS - CHARACTERISTICS ASSOCIATED WITH RESPONSE IN ANTI-HEPATITIS-C-VIRUS-POSITIVE AND ANTI-HEPATITIS-C-VIRUS-NEGATIVE PATIENTS
Dl. Thiele et al., STEROID-THERAPY OF CHRONIC HEPATITIS - CHARACTERISTICS ASSOCIATED WITH RESPONSE IN ANTI-HEPATITIS-C-VIRUS-POSITIVE AND ANTI-HEPATITIS-C-VIRUS-NEGATIVE PATIENTS, The American journal of gastroenterology, 91(2), 1996, pp. 300-308
Objectives: The goals of this study were to examine responses to corti
costeroid-containing therapy in non-B chronic hepatitis patients with
different anti-hepatitis C virus (HCV), autoantibody, and biochemical
test results and to determine what factors correlate with response. Me
thods: Patients with a prior or current history of steroid therapy for
putative autoimmune or chronic non-A, non-B hepatitis were assessed.
Responses during the first 6 months of therapy were categorized as ''c
omplete'' (normal aminotransferases for equal to or greater than 1 mon
th), ''partial'' ( > 50% reduction), or ''no response.'' Results: Suff
icient data were available to permit evaluation in 32 patients. Comple
te responses were noted in 17, partial responses in 12, and no respons
e in three subjects. By multivariate analysis, only absence of anti-HC
V and presence of cirrhosis were independent predictors of response. N
onresponders were found to have lower scores in a proposed autoimmune
hepatitis scoring system, but scores of complete and partial responder
s were not significantly different. Despite a lower likelihood of a co
mplete response, 80% (12/15) of patients with multi-antigen positive a
nti-HCV tests had either partial or complete initial responses to cort
icosteroid-containing therapy, and, in nine patients, aminotransferase
s fell to < 2 times the upper limit of normal. All 15 anti-HCV-negativ
e patients, but only three of 15 anti-HCV-positive patients, entered c
omplete responses that were sustained (aminotransferases < twofold abn
ormal) on regimens containing < 20 mg/day of prednisolone or prednison
e. Conclusions: Although anti-HCV-positive patients frequently exhibit
partial initial responses to immunosuppressive therapy, the absence o
f specific anti-HCV antibodies was better as a predictor of completene
ss of response than assessment of autoantibodies or degree of biochemi
cal abnormalities.