Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis

Pape, Simon; Gevers, Tom J.G.; Belias, Michail; Mustafajev, Ilyas F.; Vrolijk, Jan Maarten; Hoek, Bart van; Bouma, Gerd; Nieuwkerk, C.M.J. van; Hartl, Johannes; Schramm, Christoph; Lohse, Ansgar W.; Taubert, Richard; Jaeckel, Elmar; Manns, Michael P.; Papp, Mária; Stickel, Felix; Heneghan, Michael A.; Drenth, Joost P.H.

doi:10.1016/j.cgh.2018.12.035

Cited by 63 publications

(48 citation statements)

References 31 publications

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“…5 Indeed, the recommended starting dose of predniso(lo)ne, 0.5-1 mg/kg/day, is somewhat ambiguous and leaves room for variation. Recently, Pape et al 41 retrospectively investigated whether a higher (≥0.5 mg/kg/ day) or lower (<0.5 mg/kg/day) initial dose of predniso(lo)ne affected the rate of the normalization of transaminases, and found no significant difference between the two groups, even after adjusting clinical confounders; they concluded that the dose of predniso(lo)ne is less relevant than previously assumed.…”

Section: First-line Medical Treatmentmentioning

confidence: 98%

Autoimmune Hepatitis: 2019 Update

Tanaka

2020

Gut and Liver

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Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease, characterized by the elevation of aminotransferases, presence of anti-nuclear antibody or anti-smooth muscle antibody, elevated immunoglobulin G (IgG), and interface hepatitis/plasma-lymphocytic inflammation based on histology. Recent epidemiological studies have indicated an increasing trend in the prevalence of AIH worldwide, especially in male patients; this trend may suggest the alteration of environmental triggers of disease onset over time. As no disease-specific biomarker or histological finding is currently available, AIH requires a clinical diagnosis, and a validated diagnostic scoring system with acceptable specificity and sensitivity has been proposed. Regarding treatment, corticosteroids and azathioprine are recommended, and in those who exhibit an incomplete response or those who are intolerant to these drugs, second-line therapy, such as mycophenolate mofetil, is considered. Overall, the long-term outcome is excellent in patients with complete biochemical responses, while lifelong maintenance treatment may be required since the cessation of immunosuppressive agents frequently leads to the relapse of the disease. Acute-onset AIH does occur, and the diagnosis is very challenging due to the lack of serum autoantibodies or elevated IgG. The unmet needs include earlier diagnosis, intervention with disseminated clinical practice guidelines, and recognition and improvement of patients' health-related quality of life with the development of novel corticosteroid-free treatment regimens.

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Section: First-line Medical Treatmentmentioning

confidence: 98%

Autoimmune Hepatitis: 2019 Update

Tanaka

2020

Gut and Liver

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“…An initial predniso(lo)ne dose below 0.50 mg/kg/day substantially decreases unnecessary exposure to predniso(lo)ne in patients with AIH. 35 AIH patients without cirrhosis have similar survival as the general population; those with cirrhosis are at a higher risk of death. 36 Patients with cirrhosis who have acute worsening of their renal function (ie, acute kidney injury or chronic kidney injury) are at significantly higher risk of waitlist mortality than those with stable chronic kidney injury and normal renal function, even after controlling for liver disease severity.…”

Section: Few Other Pearlsmentioning

confidence: 89%

Covering the Year in CGH: 2019

Kanwal

2020

Clinical Gastroenterology and Hepatology

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“…In the present study, among 140 patients diagnosed as DILI, 55 patients (41.7%) had moderately (1:160) or strongly positive (1:320 and > 1:320) antinuclear antibodies. As is known, the differentiation between chronic DILI and AIH is important, and sometimes can be very difficult . We carefully reviewed the medical records of 55 patients (antinuclear antibody ≥1:160).…”

Section: Discussionmentioning

confidence: 99%

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

Zhu

Wang

Zhao

et al. 2019

Hepatology Research

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Aim Chronic drug‐induced liver injury (DILI) with persistent abnormal liver function tests (LFTs) >6 months after cessation of the insulting drugs could progress to cirrhosis. The aim of the present study was to identify the risk factors of chronic DILI for early recognition and better management. Methods History of drug intake and results of LFTs were retrospectively retrieved for patients with a discharge diagnosis of DILI for at least 1‐year follow up. The risk factors independently associated with chronic DILI were analyzed by multiple logistic regression analyses. Results A total of 33 of the 140 DILI patients had persistent abnormal LFTs >6 months, which were considered as chronic DILI. It was found that the time intervals of alanine aminotransferase and total bilirubin decline from the peak to their half peak (T0.5ALT, T0.5TBIL) were significantly longer in the chronic DILI group than that in the recovered group (P = 0.001 and P < 0.001). The risk factors associated with chronic DILI independently were T0.5TBIL (OR 1.315, 95% CI 1.038–1.668), longer period of insulting drug(s) intake (OR 1.018, 95% CI 1.003–1.033), mixed/cholestatic pattern (OR 97.159, 95% CI 1.866–5005.994). More importantly, receiver operating characteristic curve analysis showed that the prognostic value of T0.5TBIL for chronic DILI had a sensitivity of 60.0% at a specificity of 90.7% with the threshold of 16 days. Conclusions The time intervals of total bilirubin decline from its peak to half of its peak (T0.5TBIL) was an early independent predictive factor of chronic DILI, suggesting that T0.5TBIL might serve as an indicator for chronicity.

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Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis

Cited by 63 publications

References 31 publications

Autoimmune Hepatitis: 2019 Update

Autoimmune Hepatitis: 2019 Update

Covering the Year in CGH: 2019

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

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