LOW-DOSE CORTICOSTEROID-THERAPY AFTER MULTIPLE RELAPSES OF SEVERE HBSAG-NEGATIVE CHRONIC ACTIVE HEPATITIS

To evaluate the efficacy of low‐dose corticosteroid therapy after multiple relapses of severe HBsAg negative chronic active hepatitis, 22 patients who had relapsed on 3.4 ± 0.4 occasions (range = two to seven relapses) were treated with the lowest dose of medication necessary to ameliorate symptoms and maintain serum AST activity below five‐fold normal. Results were compared with those in 31 patients who had received conventional retreatments after 3.4 ± 0.3 relapses (range = two to eight relapses). During 44 ± 7 mo of low‐dose therapy (range = 9 to 149 mo), one patient (5%) entered sustained remission, 16 patients (72%) continued treatment, two patients (9%) died of liverrelated complications and one patient (5%) died of a nonliver‐related cause. Drug‐related side effects improved in 11 of 13 patients who had acquired them during conventional therapy (85%). The median dose of prednisone was 7.5 mg daily (range = 1 to 17.5 mg) with and without azathioprine. Thirteen patients received long‐term treatment consisting of 10 mg or less of prednisone only. Patients receiving conventional treatment entered remission more frequently than those on low‐dose therapy (97% vs. 36%, p < 0.001) but they relapsed after drug withdrawal (53% vs. 87%, p > 0.1), required continuous therapy (55% vs. 72%, p > 0.1) and died of liver‐related complications (10% vs. 9%) as commonly as those receiving low‐dose therapy. We conclude that low‐dose corticosteroid therapy in patients who have experienced multiple relapses has similar efficacy and less morbidity than conventional retreatments.(HEPATOLOGY 1990;11:1044‐1049.). Copyright © 1990 American Association for the Study of Liver Diseases