Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis.
Reduction in hepatic fibrosis and reversibility of cirrhosis has been described in chronic liver disease. Our goal was to determine changes in fibrosis and the frequency of histological cirrhosis in corticosteroid-treated autoimmune hepatitis (AIH). Three hundred twenty-five liver specimens from 87 treated patients were reviewed in batch under code by one pathologist and graded by the Ishak method. Fibrosis scores improved (3.4+/-0.2 versus 2.6+/-0.2, P=0.0002) during 63+/-6 months, and histological activity indices decreased concurrently (6.8+/-0.5 versus 2.1+/-0.2, P<0.0001). Fibrosis scores improved in 46 patients (53%) during 57+/-7 months and did not progress in 23 patients during 62+/-12 months. The fibrosis score improved more commonly in patients who had improvement in the histological activity indices than in others (61 versus 32%, P=0.02), and the frequency of histological cirrhosis decreased from 16% (14 patients) to 11% (10 patients). Fibrosis commonly improves or does not progress during corticosteroid therapy of AIH, and histological cirrhosis may disappear. Improvements in fibrosis are associated with suppression of inflammatory activity. Improvement or prevention of fibrosis may be a common but unheralded advantage of corticosteroid therapy.