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 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.
The results of the study indicated that asymptomatic patients had lower liver enzyme and IgG antibody levels, as well as lower scores on the hepatic activity index (HAI), which measures liver inflammation, but otherwise did not differ from patients with symptoms. Half of the asymptomatic patients ended up receiving treatment either because it was already started by their physicians or because they eventually developed symptoms.
"Our data suggest that it may be safe to follow asymptomatic patients with a strategy to institute immunosuppressive treatment if symptoms develop over time," the authors state, although they note that patients with no symptoms were less likely to respond to treatment than those that had symptoms.
MEDICA.de; Source: University of Toronto