Permanent immunosuppression in SLA/LP‐positive autoimmune hepatitis is required although overall response and survival are similar.

Background and aims: Antibodies against soluble liver antigen/liver pancreas (anti‐SLA/LP) are highly specific for autoimmune hepatitis (AIH) and have been linked with a more severe clinical course of the disease, frequent relapses after treatment withdrawal and worse outcome. To address definitely the clinical significance of anti‐SLA/LP, we investigated a large number of anti‐SLA/LP‐positive and ‐negative patients followed in three referral centres. Methods: Prospectively collected data from 89 anti‐SLA/LP‐positive AIH patients (29 from Hamburg‐Germany, 20 from Bologna‐Italy and 40 from Larissa‐Greece) were analysed retrospectively. Age‐ and sex‐matched anti‐SLA/LP‐negative patients served as disease controls (n = 230; 1:2.5 ratio). Results: In respect to baseline characteristics, anti‐SLA/LP‐positive patients were more frequently asymptomatic compared to anti‐SLA/LP‐negative (P <.05). However, anti‐SLA/LP‐positive patients did not differ from anti‐SLA/LP‐negative in terms of the overall response to treatment, disease progression and survival even though, they were less likely to achieve corticosteroid withdrawal (P <.05), needed longer treatment duration to achieve first complete response (P <.001) and relapsed more frequently after treatment withdrawal compared to anti‐SLA/LP‐negative patients (P = <.001). Conclusions: We showed that anti‐SLA/LP antibodies do not characterize a group of AIH patients with distinct features and cannot identify patients with a more severe form of the disease or worse survival. Most importantly, however, anti‐SLA/LP‐positive patients appear to require lifelong immunosuppression as they are less likely to achieve the cessation of corticosteroids and present higher relapse rates after treatment withdrawal. Therefore, close long‐term monitoring should be advised in all anti‐SLA/LP‐positive patients after withdrawal of immunosuppressive treatment. [ABSTRACT FROM AUTHOR]