In the Journals

Rapid response to autoimmune hepatitis treatment linked to better outcomes

Patients with autoimmune hepatitis who had a rapid response after treatment were the most likely to achieve normalization of transaminase levels in the following year and had a lower risk for liver-related death or transplantation, according to results of a retrospective study.

“Autoimmune hepatitis (AIH) is a rare, chronic liver disease that is characterized by elevated serum transaminases and immunoglobulin G (IgG), inflammatory liver histology and presence of circulating auto antibodies,” Simon Pape, PhD student from the Radboud University Medical in the Netherlands, and colleagues wrote. “Patients who do not achieve at least a 50% decrease of transaminases within 6 months run an increased risk for liver transplantation.”

To investigate the relationship between early treatment response and liver-related outcomes, Pape and colleagues reviewed the data of 370 patients with AIH treated with prednisolone. After 8 weeks of therapy, 60.8% of patients demonstrated a rapid response defined as a decrease in aspartate aminotransferase by 80% or more.

Patients with rapid response were treated with higher initial doses of prednisolone compared with slow responders (0.73 vs. 0.5 mg/kg per day; P < .001)

Rapid responders had higher transaminase levels including alanine aminotransferase (21.34 vs. 3.27; P < .001) and AST (19.29 vs. 2.61; P< .001), and total bilirubin (107 vs. 21 µmol/L; P < .001) at baseline. They were also less likely to have cirrhosis (13.8% vs. 24.1%; P = .01) and more likely to have acute-severe AIH (21.8% vs. 6.9%; P < .001) compared with slow responders.

Multivariate analysis showed that rapid responders had a higher probability for normalization of transaminases after 26 weeks (OR = 3.63; 95% CI, 1.94-6.79) and 52 weeks of treatment (OR = 4.99; 95% CI, 2.44-10.24).

Multivariate analysis also showed that rapid responders had a lower risk for liver-related death or transplantation (adjusted HR = 0.18; 59% CI, 0.05-0.63) and all-cause mortality (aHR = 0.26; 95% CI, 0.09-0.75) during a median follow-up of 6.2 years compared with slow responders. Development of hepatocellular carcinoma only occurred in the slow responder group (2.8% vs. 0%; P = .01).

After a validation analysis, the researchers confirmed the significant differences between rapid and slow responders for normalization of transaminases at 26 weeks and 52 weeks, biochemical remission, and lower risk for liver-related death or transplantation.

“The results of our study underline that a rapid and substantial amelioration of biochemical inflammatory activity is an important prognostic factor for remission of AIH,” Pape and colleagues concluded. “The absence of such a response after 8 weeks might be used to identify patients that might benefit from intensified monitoring and escalation of treatment, although this hypothesis needs future prospective research.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.

Patients with autoimmune hepatitis who had a rapid response after treatment were the most likely to achieve normalization of transaminase levels in the following year and had a lower risk for liver-related death or transplantation, according to results of a retrospective study.

“Autoimmune hepatitis (AIH) is a rare, chronic liver disease that is characterized by elevated serum transaminases and immunoglobulin G (IgG), inflammatory liver histology and presence of circulating auto antibodies,” Simon Pape, PhD student from the Radboud University Medical in the Netherlands, and colleagues wrote. “Patients who do not achieve at least a 50% decrease of transaminases within 6 months run an increased risk for liver transplantation.”

To investigate the relationship between early treatment response and liver-related outcomes, Pape and colleagues reviewed the data of 370 patients with AIH treated with prednisolone. After 8 weeks of therapy, 60.8% of patients demonstrated a rapid response defined as a decrease in aspartate aminotransferase by 80% or more.

Patients with rapid response were treated with higher initial doses of prednisolone compared with slow responders (0.73 vs. 0.5 mg/kg per day; P < .001)

Rapid responders had higher transaminase levels including alanine aminotransferase (21.34 vs. 3.27; P < .001) and AST (19.29 vs. 2.61; P< .001), and total bilirubin (107 vs. 21 µmol/L; P < .001) at baseline. They were also less likely to have cirrhosis (13.8% vs. 24.1%; P = .01) and more likely to have acute-severe AIH (21.8% vs. 6.9%; P < .001) compared with slow responders.

Multivariate analysis showed that rapid responders had a higher probability for normalization of transaminases after 26 weeks (OR = 3.63; 95% CI, 1.94-6.79) and 52 weeks of treatment (OR = 4.99; 95% CI, 2.44-10.24).

Multivariate analysis also showed that rapid responders had a lower risk for liver-related death or transplantation (adjusted HR = 0.18; 59% CI, 0.05-0.63) and all-cause mortality (aHR = 0.26; 95% CI, 0.09-0.75) during a median follow-up of 6.2 years compared with slow responders. Development of hepatocellular carcinoma only occurred in the slow responder group (2.8% vs. 0%; P = .01).

After a validation analysis, the researchers confirmed the significant differences between rapid and slow responders for normalization of transaminases at 26 weeks and 52 weeks, biochemical remission, and lower risk for liver-related death or transplantation.

“The results of our study underline that a rapid and substantial amelioration of biochemical inflammatory activity is an important prognostic factor for remission of AIH,” Pape and colleagues concluded. “The absence of such a response after 8 weeks might be used to identify patients that might benefit from intensified monitoring and escalation of treatment, although this hypothesis needs future prospective research.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.