Sustained Remission After Treatment Withdrawal in Autoimmune Hepatitis: A Multicenter Retrospective Study.

BACKGROUND: In patients with autoimmune hepatitis (AIH), relapse rates between 25 and 100% after treatment withdrawal have been reported. The optimal strategy for immunosuppressive treatment withdrawal is controversial. AIM: To identify the predictive factors of histological remission and to assess the relapse rate after treatment withdrawal in AIH patients with prolonged biochemical response. METHODS: Patients with AIH and sustained biochemical remission on first-line treatment were retrospectively included. Histological response was defined as complete regression of interface hepatitis and lobular necrosis and no or minimal portal inflammation and relapse as any elevation of serum aminotransferase or gammaglobulin/IgG levels. RESULTS: Sixty-two patients were included. Forty-seven had a biopsy after a median biochemical response of 49.7 months. Twenty-five of them were histological responders. Independent predictors of histological remission were older age (OR = 1.1; CI 95%: 1.0; 1.2), mild-to-moderate fibrosis at diagnosis (OR = 8; CI: 1.4; 47.6) and aspartate aminotransferases < 0.6 × ULN (OR = 7.1; CI: 1.3; 36.7). Thirty-nine patients stopped therapy after a median biochemical response of 48.6 months. Twenty-four of them had a biopsy before treatment withdrawal: 21 were histological responders. The cumulative rate of relapse was 25% at 64 months. CONCLUSIONS: This study indicates that older age, mild-to-moderate fibrosis at diagnosis and serum aspartate aminotransferases in the lower range of normal are independent predictors of histological response in AIH with prolonged biochemical response. The relapse rate after treatment withdrawal may be limited to 25% at 64 months when patients are selected on the basis of prolonged biochemical remission and, when available, histological response.

Bridging the gap between wellbeing and evaluation: Lessons from IBEST, a French experience.

While evaluators and advocates of alternative indicators both reflect on values and the collective construction of judgements, they do not talk much to each other. The ambition of this paper is to bridge this gap between evaluators and proponents of alternative indicators, by highlighting how an approach dedicated to the construction of alternative indicators can support evaluation practice. To do so, we draw on a participatory project conducted in Grenoble (France), that focused on the construction of indicators of sustainable wellbeing (IBEST). The project and its outputs have been used to support three evaluations over the past five years, which were each conducted with the aim of challenging policy objectives and evaluating interventions in terms of their contribution to the wellbeing of local people. Our results show that the work carried out within the framework of this type of project can feed into every stage of an evaluation. It is therefore in the interest of evaluators to integrate these alternative indicator approaches into evaluation. Moreover, this enrichment of evaluation could be useful in other places that have developed or wish to develop wellbeing indicators to support alternative policy making.