Comparative efficacy and tolerability of treatments for adult autoimmune hepatitis: A systematic review and network meta‑analysis

Abstract

The most suitable treatment regimen for autoimmune hepatitis (AIH) in adults remains unknown and requires further investigation. The current study therefore aimed to integrate evidence to provide hierarchies of the comparative efficacies of treatments measured by clinical and biochemical remission. A Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) was preformed to compare eight treatments for AIH. Eligible RCTs were identified by searching Embase, Pubmed and the Cochrane Library for publications between 1966 and April 2017. All outcomes were independently extracted from the included studies by two authors. A total of six RCTs were subsequently included in the current study. The network of comparisons on remission indicated that patients treated with prednisone (pred) experienced significantly increased rates of remission compared with those treated with azathioprine [AZA; odds ratio (OR), 0.21; 95% confidence interval (CI), 0.06–0.71] and budesonide (bude) + AZA significantly increased remission compared with placebo treatment (OR, 36.66; 95% CI, 1.40–962.49) or AZA (OR, 10.30; 95% CI, 1.50–70.70). Based on the cumulative ranking probabilities, bude + AZA (89.4) was ranked first, pred (69.1) was ranked second, pred + AZA (63.2) was ranked third and placebo (7.8) treatment was ranked last. Bude + AZA may be the most appropriate candidate for the treatment of non-cirrhotic patients. However, bude + AZA as frontline therapy for AIH requires more large-scale studies with a longer duration of follow-up histology and a focus on dose-response. Additionally, development of other prospective treatments, which may be used as alternative therapy or first line therapy, and their subsequent evaluation in clinical RCTs is required.

Effects of Combined Admistration of Imatinib and Sorafenib in a Murine Model of Liver Fibrosis

“…AIH is an immune-mediated inflammatory disorder of the liver that occurs at all ages, with women being more affected. Although most of the AIH patients respond to the standard-of-care (SOC) treatment consisting of prednisone and azathioprine, a significant percentage of them show partial or poor responses and can progress to liver fibrosis, and eventually cirrhosis [ 21 ]. The observation of the progression of some AIH patients to liver fibrosis over progression of the disease prompted us to evaluate the effects of a prolonged challenge with hepatitis-inducing doses of ConA in mice.…”

Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes

“…Budesonide plus AZA may be the most appropriate candidate for the treatment of noncirrhotic patients. 7 , 27 Unfortunately, budesonide was not available for the treatment of patients in our cohort.…”

The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis

“…Study shows that the remission rate of budesonide/AZA is higher than that of prednisone/AZA, budesonide in combination with AZA may be appropriate treatment for patients without findings of advanced liver disease [ 276 ]. However, budesonide/AZA as frontline therapy in adults with AIH requires additional large-scale studies with a longer duration of follow-up histology and a focus on dose–response [ 295 ]. Budesonide is also useful in maintenance [ 218 ], but for those who resist or on-respond to pre, budesonide may not be effective, for they share the same mechanism [ 218 , 296 ].…”