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SUMMARY Among 120 consecutive patients with chronic active liver disease (CALD) randomized to different treatments, those receiving maintenance doses of prednisone 20 mg daily (Pred), prednisone in doses given on alternate days and titrated to secure resolution of clinical and biochemical abnormalities (Pred-Titrad), or a combination of prednisone 10 mg and azathioprine 50 mg daily (Comb) survived and underwent resolution of clinical and biochemical features of disease more often than a control group receiving placebo or azathioprine 100 mg daily. Histological remission occurred significantly more often with Pred and Comb than with other regimens. Major side-effects of therapy were commoner with Pred than with Comb or Pred-Titrad, which did not differ. We conclude that Comb is the initial treatment of choice for CALD, since clinical, biochemical, and histological resolution of disease activity occurs as often as with Pred, whereas early side-effects are significantly less frequent.Advances in treatment of the related conditions comprising chronic active liver disease (CALD) include three recent controlled trials with steroids, azathioprine, or both. Cook and associates (1971) showed that variable doses of prednisolone (from 10 to 2.5 mg daily) improved certain liver function tests and survival. Therapy with prednisone 15 mg daily was found by Murray-Lyon and his colleagues (1973) to be more effective than azathioprine 75 mg daily for increasing the life expectancy of patients with chronic active hepatitis with or without cirrhosis. We showed that daily maintenance with prednisone 20 mg, or a combination of prednisone 10 mg with azathioprine 50 mg, were not only equally successful in improving survival but also secured clinical, biochemical, and histological remission of disease features significantly more often than azathioprine

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