This systematic review and meta-analysis examined treatment withdrawal strategies for patients with autoimmune hepatitis. Researchers combined data from multiple studies involving a total of 518 patients to compare two approaches: biopsy-guided withdrawal and clinically guided withdrawal. The primary goal was to see if checking liver biopsies before stopping treatment reduced the chance of the disease returning. The analysis included secondary outcomes such as how relapse was defined, the strictness of biopsy criteria, and the length of follow-up time.
The main finding showed that the pooled relapse rate after treatment withdrawal was 51.1%. When comparing the two groups, the relapse rate was 48.3% for biopsy-guided withdrawal and 56.3% for clinically guided withdrawal. The difference between these rates was not statistically significant, with a p-value of 0.604. This suggests that using biopsies to guide the decision to stop treatment does not clearly improve outcomes over standard clinical judgment.
The study also noted that relapse rates varied depending on how relapse was defined. Studies that defined relapse solely by enzyme elevation reported higher rates than those including IgG elevation. Additionally, stricter histological remission thresholds were associated with lower relapse rates and less variation in results. No safety concerns or adverse events were reported in the analysis. The authors conclude that current evidence does not clearly support routine pre-withdrawal liver biopsy for all patients with sustained biochemical remission.
