Feasibility of telehealth in the management of autoimmune hepatitis before and during the COVID-19 pandemic

Abstract

Objectives: We aimed to evaluate the feasibility of telehealth in the management of patients with autoimmune hepatitis (AIH). The COVID-19 outbreak during the study period provided an opportunity to evaluate any pandemic influence on how telehealth was perceived by patients and physicians. Methods: We included patients with AIH who were followed in the Harran University hospital, Turkey. Patients were managed by either remote telehealth or standard care. Results: A total of 46 (telehealth, n=19 and standard care, n= 27) patients (40 female) with a median age of 32 (range 17-74) years at diagnosis were included in the study. Until the start of the COVID-19 pandemic, the rates of biochemical remission and relapse after remission were similar in the telehealth and standard care groups (89.5% vs. 89.1% and 15.8% vs. 25.9%, p=ns, for both). The telehealth group maintained remission significantly better than the standard care group (100% vs. 77.3%, p=0.035) during the COVID-19 period. All relapses were due to non-adherence to therapy. Psychiatric problems, pregnancy-related issues and drug side-effects could all be managed remotely by telehealth. Conclusions: In this study, we show for the first time that telehealth is a feasible alternative for managing AIH, both under normal circumstances and during the COVID-19 pandemic. Expert opinion: Autoimmune hepatitis (AIH) requires long-life lifelong immunosuppression and followup for most patients. The use of telehealth may be an alternative way to evaluate these patients remotely. We show for the first time that telehealth is effective and useful in the management of AIH in regular time as well during COVID-19. We hope that our study can extend use of telehealth in the evaluation of patients with other causes of chronic liver disease.

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“…Because most of the reports underlined relapse is quite common after treatment discontinuation and current immunosuppressive therapy only represses inflammation temporarily and the histological improvement lags greatly behind lab test improvement, most patients need the long-term treatment except cirrhosis and significant fibrosis because they will bring forth more severe side effects [ 256 ]. As encountering a public health emergency, the telehealth system is as effective and useful in the management of AIH as in regular time [ 257 ].…”