Remission in autoimmune hepatitis: what is it, and can it ever be achieved?

The goals of therapy in autoimmune hepatitis (AIH) are to dampen inflammation within the liver, with the aim of inducing remission, improving symptoms, and prolonging survival. Ideally, treatment could be stopped once remission has been achieved. However, cessation of therapy may be complicated by relapse in substantial numbers of patients and although as many as 30% of patients could remain in remission, it is impossible to predict which patients can stop therapy safely and avoid unnecessary prolongation of immunosuppression therapy. A retrospective analysis of data from a large single centre has assessed parameters that could predict maintenance of remission following withdrawal of therapy. Importantly, it has been shown that therapy should not be withdrawn in any patient who has not achieved complete normalization of biochemistry in the presence of normal histology, nonspecific portal hepatitis, or inactive cirrhosis. The results illustrate the difficulties in relation to defining remission and relapse in patients with AIH and highlight the need for consistency in terminology.