A 42-year-old woman with autoimmune hepatitis (AIH) achieves complete biochemical remission (normal ALT, normal IgG) on azathioprine 100 mg/day after 3 years of treatment. She wishes to stop medication. According to EASL guidelines for AIH, the minimum recommended duration of treatment before considering withdrawal is:
- A At least 3–5 years of treatment with complete histological remission on biopsy ✓
- B 6 months of complete remission
- C At least 2 years of continuous treatment with sustained remission
- D Treatment is lifelong and should never be stopped
Explanation
EASL 2015 guidelines for AIH recommend a minimum of 3 years of treatment and at least 24 months of complete biochemical remission before attempting drug withdrawal. Furthermore, a liver biopsy should ideally confirm histological remission (absence of interface hepatitis, normal histology) before withdrawal, as biochemical remission does not always equate to histological remission. Relapse occurs in 50–80% after drug withdrawal, often within 6–12 months. Patients without cirrhosis, IgA deficiency (normal IgA), and anti-SMA negative have better withdrawal success. Many guidelines now suggest 3–5 years with biopsy confirmation before withdrawal attempt.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.