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Background and Aims: Azathioprine (AZA) and prednisone (PD) are the standard treatment (ST) for the onset or relapse of autoimmune hepatitis (AIH). Antimalarials were effective for maintenance of remission of AIH after immunosuppression withdrawal. Our aim is to describe a series of patients who relapsed after antimalarial withdrawal and achieved biochemical remission after reintroduction of chloroquine in monotherapy. Methods: Eight patients received chloroquine diphosphate (DCQ) 250mg/d or hydroxichloroquine (HCQ) 400-800mg/d in monotherapy for biochemical remission after relapse. The schedule is described below: histological remission (HR) with ST → ST withdrawal and antimalarial use for maintenance of remission for 1-3y → antimalarial withdrawal → relapse of AIH → reintroduction of antimalarial instead of ST, at the request of patient due to corticosteroids side effects (SE). Four out of 8 patients underwent liver biopsy to evaluate HR after at least 18mo of biochemical remission. Results: Mean age at diagnosis of AIH of 36.2 ± 20.4y; 6 type-1, 2 anti-SLA/LP (5 reactive in 7 tested); 3 with cirrhosis at diagnosis. Mean doses of AZA/PD at HR were, respectively, 84.4 ± 18.6 and 9.4 ± 2.2mg/d. Mean interval between antimalarial withdrawal and relapse was 20.5 ± 34.1mo. Mean ALT at relapse was 139.7 ± 54.2 U/L. Three patients received DCQ and 5 HCQ. During HCQ intake 1 patient needed further adjustment of drug to 800 mg/d for 15 days due to worsening of ALT from 130 to 246 U/L, with subsequent reduction to the initial dose. Seven patients achieved biochemical remission, in a mean time of 14.2 ± 19.9mo; 3/4 had histological remission. The drug was well tolerated and there were no serious SE. Conclusions: CQ monotherapy was safe and effective for induction of remission in this subgroup of AIH. This finding raises arguments to include this drug as an option for treatment of AIH, not necessarily in monotherapy.

Introduction: Low Phospholipid-Associated Cholelithiasis (LPAC) is a clinical spectrum of Progressive Familial Intrahepatic Cholestasis type 3 (PFIC3), with mutations in the ABCB4 gene, reduced levels of phosphatidylcholine in bile, formation of cholesterol gallstones, damage of bile ducts epithelium and cholestasis. Ursodeoxycholic acid (UDCA) is effective and fibrates may also be used to activate PPAR-α receptor, inducing bile secretion of phosphatidylcholine. Aim: Retrospectively evaluate efficacy and safety of ciprofibrate in LPAC/PFIC3. Method: Diagnosis of PFIC3 was confirmed by detection of mutations of ABCB4 gene. LPAC diagnosis was suggested by 2 out of 5 criteria: biliary symptoms before 40 years; recurrence after cholecystectomy; intrahepatic lithiasis; cholelithiasis in first‐degree relatives; intrahepatic cholestasis of pregnancy or contraceptive‐induced cholestasis. Enzymes, liver function and pruritus were analyzed after 3, 6 and 12 months of UDCA and after ciprofibrate 100mg/day using the Wilcoxon test. Results: 27(93%) patients with clinical diagnosis of LPAC and 2 of PFIC3. 23 (79%) female with mean age at onset of symptoms of 26.7±13.6 years. 23(80%) had family history of biliary disease; 22(76%) cholelithiasis before 40 years; 7(24%) intrahepatic lithiasis. 22/29 (78%) received ciprofibrate after 4.5±4.9 months of UDCA use, in a mean dose of 13.1±2.2mg/kg/day. During UDCA there was a significant decrease in aminotransferases, alkaline phosphatase(AP) and gamma-glutamyltransferase(GGT) levels, without significant improvement in the liver function. After addition of fibrate, pruritus disappeared in all 7 patients, with significant improvement of AP, GGT and albumin in the third month. There was no significant renal dysfunction. Fibrate was discontinued in 8: 1 liver transplantation, 2 irregular use, 5 side effects. 27 patients are still in follow up. Conclusion: Ciprofibrate was beneficial to improve pruritus and laboratory tests in LPAC/PFIC3 after partial response with UDCA. Fibrate therapy was safe and well tolerated.

Introduction: 15% of patients with autoimmune hepatitis (AIH) are refractory to usual treatment. The management of these cases is still challeging. Aims: To evaluate the efficacy and safety of cyclosporine (CYA), mycophenolate (MMF) and tacrolimus (FK). Methods: This is a retrospective study with alternative therapies (AT) for non-response or intolerance to azathioprine (AZA) and prednisone (PD). Biochemical remission (BR) was defined as the normalization of AST and ALT; and histological remission (HR) as periportal activity 0/1 or histological activity index