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Therapy may not be necessary for autoimmune hepatitis with no symptoms

It is not uncommon for patients with autoimmune hepatitis (AIH), a disease in which the patient's own immune system attacks the liver, to have no symptoms. Such cases are being diagnosed more frequently due to the increased practice of administering routine liver enzyme and antibody tests. Whether or not to treat asymptomatic AIH remains unclear--therapy with immunosuppressants could potentially slow progress of the disease but involves side effects that are sometimes toxic.

In order to determine if immunosuppressive therapy is indicated when no symptoms are present, researchers led by Jordan J. Feld, M.D. of the Departments of Medicine and Pathology at the University Health Network of the University of Toronto, compared the natural course of asymptomatic AIH with symptomatic AIH.

The results of the study appear in the July 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc. Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

The study included 124 patients diagnosed with AIH at the Toronto Western Hospital Liver Clinic between 1970 and 2002 31 of whom were asymptomatic. Researchers reviewed the patients' clinical records to document the presence or absence of symptoms. Patients were considered asymptomatic if they were free of all symptoms, even non-specific ones such as fatigue or abdominal pain. Immunosuppressive therapy was recommended for all symptomatic patients, while asymptomatic patients were not treated, unless treatment had already been initiated. Patients who developed symptoms during the study period were started on immunosuppressive therapy. If they remained in remission for two years with no relapse the therapy was discontinued, but it was restarted if the disease recurred off treatment.

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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
22-Jun-2005


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