Estudo randomizado de cloroquina versus azatioprina, em associação com prednisona, no tratamento da hepatite autoimune

Abstract

Background: The treatment of autoimmune hepatitis (AIH) with prednisone and azathioprine provides disease remission. However, a complete biochemical and histological response is unreachable in most patients. Chloroquine is an antimalarial drug used for treating rheumatological diseases. It was studied as a single drug for the maintenance of AIH remission in an open study, which suggested a lower risk of relapse in the chloroquine group. Aims: To evaluate a possible role of chloroquine and prednisone for AIH treatment in a randomized study. Methods: 57 AIH adult patients with indication of treatment were enrolled to receive azathioprine or chloroquine, both with varying doses of prednisone, from 2003 to 2012. For those who had maintained biochemical remission for 18 months, liver biopsy was performed to evaluate histological remission. The primary outcome was the achievement of complete response to treatment. A p-value < 0.05 was considered statistically significant. Results: There were no significant differences between the groups concerning clinical, serological, histological, and treatment features at baseline. The average age was 37.2 ± 16.84 years, 43.8% with advanced fibrosis (F3/4) at baseline. There was no statistical differences in biochemical (67.7% vs. 53.8%, p=0.41) or histological response rate (32.26% vs. 15.38%, p = 0.217), as well as in the mean prednisone dose. There was a higher rate of adverse effects in the chloroquine group, but a lower frequency of comorbidities in this group. Conclusion: When well tolerated, chloroquine with prednisone provided a complete therapeutic response in AIH patients with no statistical difference when compared to the standard treatment. (ClinicalTrials.gov NCT 02463331).

Hepatite autoimune decorrente de infecção por SARS-CoV-2: um relato de caso

“…O acompanhamento regular com exames de sangue para monitorar a função hepática e a resposta ao tratamento é essencial para ajustar a terapia, se necessário. (29) Caso o tratamento não seja realizado adequadamente, a HAI pode levar a uma série de complicações, incluindo fibrose, cirrose e insuficiência hepática. Além disso, a hepatite autoimune aumenta o risco de desenvolvimento de doenças hepatobiliares, como colangite esclerosante primária e hepatocarcinoma.…”

Associação entre obesidade e os níveis séricos de vitamina D

“…A avaliação do grau de incapacidade visa identificar e descrever as deficiências sensório-motoras nos olhos, mãos e pés, e varia de 0 a 2, é de suma importância para o acompanhamento do paciente. O grau 0 corresponde à ausência de incapacidades, nas áreas avaliadas; o grau I diz respeito à diminuição ou perda da sensibilidade nessas regiões do corpo e o grau II se refere a alterações motoras nessas partes do corpo ou deformidades visíveis e está relacionado à classificação da doença, tempo de evolução e ocorrência de reações hansênicas (Moraes, et al, 2018). Compreende-se, portanto, que as pessoas diagnosticadas com hanseníase e GIF 2 têm o diagnóstico tardio.…”