Standard Treatment in Adults: Which XXXX ? Or without Steroids?

@entity1 @entity32 @entity82 @entity500 @entity4184 @entity775 @entity99 @entity6051 @entity617 @entity479
UNASSIGNED: Key Messages: (1) Standard treatment of @entity775 in adults should be @entity479 based. In early trials, @entity617 +/- @entity500 was superior to the @entity500 mono-therapy (which was not significantly better than placebo). @entity617 plus @entity500 has similar efficacy to, but is better tolerated than a higher-dose of @entity617 alone and therefore has become standard therapy. (2) In most treated patients, serum transaminases and globulin/IgG fall, but percentage attaining normal values within 6 months varies between 10 and 90%. @entity1 failing to do so have a worse longer-term outcome. (3) A higher initial @entity617 dose (1 mg/kg/day) plus @entity500 achieved 76% serum transaminase normalisation after 6 months but needs longer-term evaluation. (4) Histological remission (minimal @entity99 on re-biopsy) lags behind transaminase normalisation by 6-12 months and is achieved in 55-70% of @entity1 after 24-36 months @entity617 . This lag and the inefficacy of @entity500 mono-therapy justifies continuing @entity617 (5-10 mg/day), even after transaminase normalisation, for a total of >2 years. (5) Repeat biopsy should be considered because 40-60% of @entity1 still have (usually mild) persisting @entity32 , despite normal serum transaminases and IgG. In such @entity1 , @entity82 is less likely to regress and long-term mortality is higher. (6) In a large trial, non-cirrhotic treatment-na  ve @entity1 given @entity4184 (9 mg/day) plus @entity500 were more likely to achieve normal serum ALT after 6 months than those receiving @entity617 plus @entity500 and had less side effects. This trial was short term in nature and lacked follow-up histology. @entity4184 is recommended in non-cirrhotic @entity1 who develop @entity617 -related side effects. In an open study of @entity6051 plus @entity617 , 88% of treatment-na  ve @entity1 achieved normal serum transaminases. However, half relapsed during or after @entity479 withdrawal and only one of eight re-biopsied @entity1 achieved histological remission. @entity6051 is teratogenic, limiting its use in younger @entity1 . CONCLUSION: Despite its limitations, no regime has yet been shown clearly to be better than @entity617 and @entity500 -based therapy.
