Ursodeoxycholic acid can be used as a streoid-tapering drug in the treatment of autoimmune hepatitis
Küçük Resim Yok
Tarih
2001
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kortikosteroidler otoimmün hepatit tedavisinde kullanılan ilaçlardandır. Azathioprin de daha etkili immünosüpresyon sağlamak ve kortikosteroidler dozunu azaltmak amacıyla kullanılmaktadır. Otoimmün hepatit olguların %20-40'ında Standard tedavi rejimine yanıt alınamaz ya da uzun süreli yüksek doz kortikosteroidler tedavi vermek gerekebilir. Ursodeoksikolik asit bir miktar immünomodülatör etkiye sahip olduğundan otoimmün hepatit tedavisine katkıda bulunabileceği düşünülebilir. Biz, standard kortikosteroidler tedasine dirençli otoimmün hepatit tip 1 olgularda Ursodeoksikolik asit etkinliğini araştırdık. Yöntem: Eylül 1997- Eylül 1999 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hepatoloji kliniğinde 23 olguya otoimmün hepatit tip 1 tanısı koyduk. Tüm olgulara (4 erkek ve 19 kadın, ortalama yaş 42±12) kortikosteroidler ve/ veya azathioprin tedavisi uygulandı. Kortikosteroidler tedavisi 15 mg/ gün altına indirilemeyen veya 6. ayın sonunda ALT düzeyi normale inmeyen 7 olguya (3 erkek ve 4 kadın, ortalama yaş 43±7) almakta oldukları tedaviye ek olarak Ursodeoksikolik asit (750 mgl gün) verildi. Bulgular: Ursodeoksikolik asit eklenen olguların tedavi önceki ortalama AST ve ALT değerleri sırasıyla 130.8±72.0 U/l ve 126.1±96.6 U/l idi. Ursodeoksikolik asit tedaviye eklendikten 3 ay sonra olguların tümünde ALT değerleri normal bulundu. Prednisolon 10 mg/ gün veya altındaki dozlar ile yeterli remisyon sağlandı. Sonuç: Kortikosteroidler tedaviye yanıt alınmayan veya yüksek doz kortikosteroidler tedavi kullanılmak zorunda kalınan otoimmün hepatit tip 1 tanılı olgularda Ursodeoksikolik asitin tedaviye eklenmesi düşünülmelidir. Bu konu ile ilgili olarak daha gerçekçi sonuçlar çıkarmak için plasebo kontrollü randomize çalışmalara gereksinim vardır.
Background/aims: Corticosteroids are the drug of choice for the treatment of autoimmune hepatitis . Azathioprine is also prescribed to allow a decreased dosage of corticosteroids and to provide more efficient immunosuppression. Almost 20-40 % of patients with autoimmune hepatitis do not respond to the standard treatment regimen or require higher doses of corticosteroids for a longer period of time. Due to its immunomodulatory effects, ursodeoxycholic acid is thought to contribute to autoimmune hepatitis treatment. This study investigated the efficacy of ursodeoxycholic acid administration in the treatment of patients with autoimmune hepatitis type 1, who were resistant to Standard corticosteroid treatment. Methods: Between 1997 and 1999, 23 patients were diagnosed as autoimmune hepatitis type 1 in Ege University Hospital. Corticosteroids and / or Azathioprine treatment were administered to all patients (four male and 19 female, mean age 42+12 years). Ursodeoxycholic acid (750 mg/day) was added to the treatment of seven (20%) of these patients (three male and four female, mean age 43±7 years) whose ALT values had not returned to normal levels by the end of the sixth month or whose corticosteroid dose could not be decreased to 15 mg/ day or less. Results: Pre-treatment ALT and AST values of the patients who were prescribed ursodeoxycholic acid were 130.8±72.0 U/l and 126.1±96.6 U/l respectively. After three months of ursodeoxycholic acid administration, ALT values of all patients were found to be normal. Sufficient remission was provided with prednisolone dosages of 10 mg/day or less. Conclusions: Ursodeoxycholic acid should be considered as a supplementary treatment for patients with autoimmune hepatitis type 1 who require high-dosage steroid treatment or do not respond to corticosteroid treatment. Randomized studies with placebo controls are needed in order to obtain more accurate results.
Background/aims: Corticosteroids are the drug of choice for the treatment of autoimmune hepatitis . Azathioprine is also prescribed to allow a decreased dosage of corticosteroids and to provide more efficient immunosuppression. Almost 20-40 % of patients with autoimmune hepatitis do not respond to the standard treatment regimen or require higher doses of corticosteroids for a longer period of time. Due to its immunomodulatory effects, ursodeoxycholic acid is thought to contribute to autoimmune hepatitis treatment. This study investigated the efficacy of ursodeoxycholic acid administration in the treatment of patients with autoimmune hepatitis type 1, who were resistant to Standard corticosteroid treatment. Methods: Between 1997 and 1999, 23 patients were diagnosed as autoimmune hepatitis type 1 in Ege University Hospital. Corticosteroids and / or Azathioprine treatment were administered to all patients (four male and 19 female, mean age 42+12 years). Ursodeoxycholic acid (750 mg/day) was added to the treatment of seven (20%) of these patients (three male and four female, mean age 43±7 years) whose ALT values had not returned to normal levels by the end of the sixth month or whose corticosteroid dose could not be decreased to 15 mg/ day or less. Results: Pre-treatment ALT and AST values of the patients who were prescribed ursodeoxycholic acid were 130.8±72.0 U/l and 126.1±96.6 U/l respectively. After three months of ursodeoxycholic acid administration, ALT values of all patients were found to be normal. Sufficient remission was provided with prednisolone dosages of 10 mg/day or less. Conclusions: Ursodeoxycholic acid should be considered as a supplementary treatment for patients with autoimmune hepatitis type 1 who require high-dosage steroid treatment or do not respond to corticosteroid treatment. Randomized studies with placebo controls are needed in order to obtain more accurate results.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Turkish Journal of Gastroenterology
WoS Q Değeri
Scopus Q Değeri
Cilt
12
Sayı
4
