Autoimmune hepatitis in patients aged 70 years or older: Disease characteristics, treatment response and outcome

Abstract

Background & Aims Autoimmune hepatitis (AIH) affects both sexes and all age groups. However, very few studies have focused specifically on the characteristics and outcome of AIH in patients aged 70 y or older. Methods 25/234 patients with well‐established AIH and disease onset at ≥70‐y (median: 73‐y) were analysed and compared to the rest patients (median: 47 y). Treatment response was assessed in all patients from both groups who were eligible for treatment (n = 202). Results Disease presentation was mainly insidious in both groups (19/25, 76% vs. 134/209, 64.1%; P = .313). At diagnosis, older patients had lower alaninoaminotrasferase (101[433] vs. 199[441] IU/L, P < .05) but were more frequently cirrhotic (12/25, 48% vs. 57/209, 27.3%; P = .03). Importantly, similar rates of on‐treatment response (16/18, 89% vs. 154/184, 84%; P = .565), corticosteroid withdrawal (10/16, 62.5% vs. 113/154, 73.4%; P = .355) and complete withdrawal of immunosuppression (1/16, 6.3% vs. 40/154, 26%; P = .122) were achieved in both groups. Treatment‐related adverse events were evenly observed between groups (6/18, 33% vs. 54/184, 29%; P = .724). In treated patients, the age ≥70 y was only associated with the overall mortality (HR 8.3 [95% CI: 2.1‐36.4], P = .003), but not with the liver‐related mortality (HR 3.4 [95% CI: 0.4‐30.0], P = .268). Conclusion AIH should be seriously considered in patients ≥70 y with unexplained impaired liver function tests as the disease is not infrequent in this group and seems to bear an increased risk for advanced disease stage at diagnosis. However, if immunosuppression is started promptly, it seems as safe and effective as in younger patients.

First Results From a Propensity Matching Trial of Mycophenolate Mofetil vs. Azathioprine in Treatment-Naive AIH Patients

“…We used the propensity score matching to compare patients between MMF and AZA groups. Propensity score was obtained by using logistic regression analysis including as covariates known factors that could affect the response to treatment and outcome (age, sex, the presence of cirrhosis at baseline, disease duration, seropositivity for anti-SLA/LP or anti-LKM, clinical severity of the disease, IgG levels, necroinflammatory activity, and fibrosis stage) (32,(34)(35)(36). Matching was performed 1:1 with the nearestneighbor method within caliper bounds of ±0.2 (37,38).…”

Long-term results of mycophenolate mofetil vs. azathioprine use in individuals with autoimmune hepatitis

“…The presentation of AIH was considered ‘acute’ when patients had, at onset, aminotransferases >10 × the upper limit of normal (ULN) with or without clinically evident jaundice and ‘insidious’ when deranged liver biochemistry was found in conjunction with or without non-specific general symptoms such as fatigue, arthralgias, malaise, and anorexia. 17 , 18 , 21 , [24] , [25] , [26] The ‘acute-severe’ variant was defined as an acute presentation of newly (<24 weeks) diagnosed acute episode of hepatitis with or without hepatic encephalopathy characterised by elevated international normalised ratio (INR) ≥1.5 at any time during the acute course and without lesions of chronic disease on histology. 24 , 27 All patients were systematically evaluated during follow-up (75 ± 62 months) every 3–6 months by physical and laboratory examination.…”

“…According to the guidelines and our previous works, antinuclear antibodies (ANA), smooth muscle antibodies (SMA), anti-liver cytosol type-1 (anti-LC1), and anti-liver/kidney microsome type-1 antibodies (anti-LKM1) were initially investigated by indirect immunofluorescence on 5-μm fresh frozen sections of in-house rodent multi-organ (kidney, liver, and stomach) substrates. 2 , 3 , 17 , 18 , [24] , [25] , [26] Anti-LC1, anti-LKM1, and antibodies against soluble liver antigen/liver pancreas (anti-SLA/LP) were also assessed by Western blotting using rat liver microsomal or cytosolic extracts. Commercially available ELISA kits using recombinant formininotransferase cyclodeaminase (Euroimmune, Medizinische Labor Diagnostika AG, D23560 Lubeck, Deutschland), cytochrome P450 2D6 (INOVA, Diagnostics Inc., San Diego, CA, USA), and SLA/LP/tRNP(Ser)Sec (INOVA) antigens were also used for the detection of anti-LC1, anti-LKM1, and anti-SLA/LP, respectively, according to the manufacturer’s instructions.…”

Serum Cartilage Oligomeric Matrix Protein and Golgi Protein-73: New Diagnostic and Predictive Tools for Liver Fibrosis and Hepatocellular Cancer?

“…Cirrhosis was diagnosed according to our previous publications. In brief, in patients without liver biopsy, cirrhosis was diagnosed by liver ultrasound (coarse echo-pattern of the liver in association with irregular margins of the parenchyma, spleen length above 12 cm, portal vein diameter above 16 mm), TE, supporting findings in endoscopy (esophageal varices, portal gastropathy), and/or clinical signs of decompensated cirrhosis (presence of ascites, history of variceal bleeding, hepatic encephalopathy) [16][17][18]29,30]. The diagnosis of HCC was made by standard findings on histology and/or radiology [4,5].…”