Reply:†
Potential conflict of interest: Nothing to report.
We read with pleasure the correspondence by Muratori et al. on the new 2010 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines on “Diagnosis and Management of Autoimmune Hepatitis.”1 The authors appreciate the new definition of biochemical remission, which now requires normal levels of serum aminotransferases. They have provided data of their 163 consecutive Italian patients with autoimmune hepatitis from a single center that have been partially published before.2
The application of the 2010 criteria reduces the biochemical remission rate in their cohort from 73% to 26%. The authors also provide data that only patients achieving the 2010 AASLD criteria of remission have a good long-term prognosis whereas their patients who did not achieve normal ALT had a high probability of developing long-term complications. Muratori et al. provide very important data to support the adequateness of the new 2010 AASLD Practice Guidelines on autoimmune hepatitis concerning remission. Recently, the largest ever prospective study on the therapy of autoimmune hepatitis, that compared budesonide and prednisone each in combination with azathioprine, also used normalization of alanine aminotransferase as an endpoint.3 In this study, 60% of patients in the budesonide arm versus 39% in the prednisone arm achieved normal alanine and aspartate aminotransferases at 6 months. We agree with Muratori et al. that the new definition of biochemical remission helps to identify patients at risk for disease progression who need new pharmacological approaches.
References
Michael P. Manns M.D.*, Albert J. Czaja M.D. , James D. Gorham M.D., Ph.D. , Edward L. Krawitt M.D.§, Giorgina Mieli-Vergani Ph.D.¶, Diego Vergani M.D., Ph.D.**, John M. Vierling M.D. , * Medical School of Hannover, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany, Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN, Dartmouth Medical School, Department of Pathology, Lebanon, NH, § University of Vermont College of Medicine, Department of Medicine, Given Building, Burlington VT, ¶ Pediatric Liver Centre, King's College London School of Medicine at King's College Hospital, Denmark Hill, London, UK, ** Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill, London, UK, Baylor Liver Health, Baylor College of Medicine, Houston, TX.