REPLY
Methotrexate in Idiopathic Granulomatous Hepatitis
Tamsin A. Knox, MD, and
Marshall M. Kaplan, MD
1 November 1995 | Volume 123 Issue 9 | Page 733
IN RESPONSE:
In Dr. Shea and colleagues' patient, prednisone was not completely withdrawn and symptoms and signs of disease returned within 6 months of the discontinuation of hydroxychloroquine therapy. Of our seven patients who received methotrexate therapy [1], none required concurrent corticosteroid therapy. In the three patients in whom methotrexate was withdrawn, signs and symptoms of disease did not return. We do not believe that "spontaneous resolution of symptoms," occasionally seen with idiopathic granulomatous hepatitis, was responsible for the remission induced in our patients in the short period of 1 week to 3 months after methotrexate was started, particularly in those who required high-dose corticosteroids.
Like methotrexate and prednisone, hydroxychloroquine has known toxicities, including retinal damage and blood dyscrasias. More data are needed to compare the efficacy of these two drugs in treating idiopathic granulomatous hepatitis.
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Author and Article Information
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New England Medical Center; Boston, MA 02111
1. Knox TA, Kaplan MM, Gelfand JA, Wolff SM. Methotrexate treatment of idiopathic granulomatous hepatitis. Ann Intern Med. 1995; 122:592-5.
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