CYCLOSPORINE IN THE MANAGEMENT OF CORTICOSTEROID-RESISTANT TYPE-I AUTOIMMUNE CHRONIC ACTIVE HEPATITIS

Autoimmune chronic active hepatitis is traditionally treated with cort icosteroids, or corticosteroids with azathioprine. These drug therapie s require long treatment periods and are associated with many debilita ting drug side effects. Five patients with type I autoimmune chronic a ctive hepatitis, and one with a probable overlap syndrome were treated with cyclosporine. All patients had previously undergone treatment wi th corticosteroids or corticosteroids with azathioprine and had failed to achieve total remission. In addition, all patients had significant side effects associated with therapy. Five of six patients normalized or near normalized alanine aminotransferase levels within 10 weeks of starting cyclosporine therapy. Biochemical remission was sustained fo r periods of up to 1 year in all primary cyclosporine responders as lo ng as therapeutic cyclosporine levels were maintained. All responders had symptomatic improvement. Post-treatment liver biopsy was performed in three patients and histologic improvement was demonstrated in all cases. Cyclosporine appears to be a viable alternative to corticostero id/azathioprine therapy for autoimmune chronic active hepatitis in pat ients who experience an incomplete response or who cannot tolerate the side effects of standard therapy. (C) Journal of Hepatology.