MANAGEMENT OF CHRONIC AGGRESSIVE HEPATITIS IN CHILDREN AND ADOLESCENTS

A ten-year prospective study of 26 children and adolescents (age range: 3.5 to 15.75 years; mean age 10.25 years) with symptomatic HBsAg-negative chronic aggressive hepatitis is presented. Daily high-dose prednisone therapy was initially prescribed to secure clinical and biochemical remission, and then an alternate-day steroid program was instituted to maintain the state of remission. Azathioprine was added to the regimen (in three children) if remission was not secured after three months of daily prednisone therapy or if frequent relapses precluded reduction of the predanisone dosage. The mean duration of treatment was 19 months. Clinical and biochemical remission was achieved in all children and histologic remission was demonstrated in 17 children. No steroid complications, treatment failures, morbidity, or mortality were noted during this study. Nineteen children have been off therapy for two to 122 months (mean=69 months) and continue to demonstrate clinical and biochemical remission. Therapy is being progressively decreased in the seven remaining patients. We conclude from our study that high-, single-dose prednisone therapy (daily initially, then on alternate days) will effectively suppress HBsAg-negative CAH in children and adolescents without the production of adverse effects of therapy. © 1979 The C. V. Mosby Company.