Failure of customary treatment in chronic active liver disease: causes and management. Ann Clin Res 1976 Jun;8(3):221-7
Date
06/01/1976Pubmed ID
793499Scopus ID
2-s2.0-0017069485 (requires institutional sign-in at Scopus site) 74 CitationsAbstract
Among 134 patients with chronic active liver disease, selected by identical clinical, biochemical and morphologic criteria, assigned to standard treatment programs and followed at regular intervals, 21 of 105 failed treatment with standard regimens containing steroids. Treatment failure was more common in patients whose serum contained hepatitis B surface antigen, those with more severe liver disease as judged by liver function tests (prothrombin time) and hepatic morphology (subacute hepatitis or cirrhosis). Early diagnosis of treatment failure, based on changes in liver function tests rather than on clinical features of deterioration, coupled with the immediate administration of higher doses of prednisone with or without higher doses of azathioprine, resulted in disappearance of clinical and biochemical features of disease activity in the majority of patients. These results were greatly superior to those earlier reported by us from patients chosen by identical criteria but treated by conventional measures. However, when endogenous encephalopathy developed the outlook was grave, regardless of previous or subsequent therapy. We recommend that patients at risk for failing conventional treatment be identified early, followed carefully with serial liver function tests, and be treated promptly with higher doses of medication when deterioration occurs.
Author List
Schalm SW, Ammon HV, Summerskill WHAuthor
Helmut V. Ammon MD Adjunct Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AzathioprineChronic Disease
Clinical Trials as Topic
Drug Therapy, Combination
Evaluation Studies as Topic
Humans
Liver Diseases
Prednisone
Prognosis
Remission, Spontaneous
Time Factors