TREATMENT OF CHRONIC ACTIVE HEPATITIS WITH EITHER PREDNISOLONE OR CORTICOTROPIN - CONTROLLED TRIAL

Abstract

A total of 54 patients hospitalized for chronic active hepatitis were randomly treated, 29 with prednisolone (maintenance dose 15 mg/day) and 25 with depot synthetic corticotropin (maintenance dose 1 mg/week, i.m.) and were followed up for 6-24 mo. or longer. In this series, young males predominated, the incidence of serum HBSAg [hepatitis B antigen] positivity approached 80% in both treatments and no patient had initial evidence of cirrhosis or had autoimmune associated diseases. With either drug SGOT [serum glutamic oxaloacetic transaminase] levels showed a decrease during the initial 12 mo. of therapy (P < 0.05); initial jaundice, when present, had disappeared by the 3rd mo. of treatment. With both treatments globulins and .gamma.-globulins decreased significantly after 12-24 mo. of therapy. Serum HBSAg persisted in all but 2 cases. Serial liver biopsies showed the following evolutions of histological activity: 12 cases (22%) improved to the inactive phase (8 with prednisolone and 4 with corticotropin); 19 (35%) improved to a lesser extent (8 with prednisolone and 11 with corticotropin); 17 (32%) remained unchanged (11 with prednisolone and 6 with corticotropin); 6 (11%) worsened (2 with prednisolone and 4 with corticotropin). Morphological features of cirrhosis apparently developed in 15 patients (8 treated with prednisolone and 7 with corticotropin) of whom 7 achieved improvement of histological aggressiveness concurrently. Differences between treatments were not significant. Side effects suggesting drug discontinuation occurred only in 6 cases.