Efficacy of cyclosporin A in children with type 2 autoimmune hepatitis

The conventional treatment of autoimmune hepatitis (AIH) with prednisone an d azathioprine induces remission in most cases but is often associated with poorly tolerated side effects. We carried out a retrospective study to eva luate the efficacy of and the tolerance to cyclosporin treatment in 15 chil dren and adolescents with type 2 AIH. Eight children received cyclosporin a s primary immunosuppression because of risk factors for poor tolerance of s teroids. Five other patients with relapsing AIH refused to resume treatment with steroids and were treated with cyclosporin. In both groups alanine am inotransferase activity returned to normal within 6 months. Side effects we re minimal and well tolerated. No relapse occurred in 10 patients after 1 t o 6 years. Cyclosporin was withdrawn in 3 patients after 1, 2, and 3 years and replaced by low doses of prednisone in combination with azathioprine. I n 2 other children with acute liver failure, which progressed despite treat ment with steroids and azathioprine, the addition of cyclosporin was follow ed by normalization of prothrombin time.