CYCLOPHOSPHAMIDE AS ALTERNATIVE IMMUNOSUPPRESSIVE THERAPY FOR AUTOIMMUNE HEPATITIS - REPORT OF 3 CASES

Autoimmune hepatitis is a chronic inflammatory disorder of the liver w ith a fluctuating course, which often requires long-term immunosuppres sive therapy in order to prevent fibrosis to tile liver, The mainstay of immunosuppressive therapy is the use of corticosteroids, usually in conjunction with azathioprine. However, in a subgroup of patients wit h severe side effects or intolerance of standard therapy there is a ne ed for alternative immunosuppressive agents. We describe tile successf ul long-term treatment of three patients with severe autoimmune hepati tis with an immunosuppressive regimen consisting of cyclophosphamide a nd corticosteroids. In tile reported patients we were able to induct r emission with cyclophosphamide in a dose of 1-1.5 mg/kg bodyweight in combination with a tapering dose of corticosteroids beginning with 1 m g/kg bodyweight. After induction we were able to maintain histology pr oven remission with low doses of corticosteroids (2.5-10 mg/day) toget her with 50 mg of cyclophosphamide every other day, With this dose of cyclophosphamide we hate neither observed relapse of autoimmune hepati tis nor severe side effects in a cumulative observation period of more than twelve years in the three patients. As a consequence of our favo urable experience with cyclophosphamide in the reported cases, we prop ose cyclophosphamide as an alternative to azathioprine in cases of aut oimmune hepatitis with severe side effects of intolerance of standard therapy.