STEROID-THERAPY OF CHRONIC HEPATITIS - CHARACTERISTICS ASSOCIATED WITH RESPONSE IN ANTI-HEPATITIS-C-VIRUS-POSITIVE AND ANTI-HEPATITIS-C-VIRUS-NEGATIVE PATIENTS

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.