The efficacy and safety of different doses of glucocorticoid for autoimmune hepatitis

Abstract

Background: Glucocorticoid as the standard treatment of autoimmune hepatitis has been recommended with different doses. The purpose of this study is to compare the efficacy and safety of high and low doses for clinical practice.Methods: Medline, Embase, and Cochrane Library were searched until January 16th, 2019 for cohort studies or randomized controlled trials in patients with autoimmune hepatitis. Glucocorticoid 60 mg/d or 1 mg/kg/d was defined as high dose and 40 to 50 mg/d or 0.5 mg/d as low dose. Outcome of interests includes the incidence of the biochemical remission, adverse event, and endpoint events. Double arcsine method with a random-effect model was used to combine the incidence. Potential heterogeneity was explored by meta-regression and subgroup analysis.Results: Overall, 25 studies (3305 patients) were included, with 10 studies in the high dose group and 15 in low dose group. The biochemical remission rate in the high and low dose group was 0.79 (95% confidence interval [CI] [0.72, 0.85]) and 0.72 (95% CI [0.65, 0.78]), respectively. The incidence of endpoint events and adverse event in the high were slightly higher (0.03, 95% CI [0.02, 0.04]; 0.42, 95% CI [0.30, 0.53]) than that of the low dose group (0.01, 95% CI [0.00, 0.01]; 0.39, 95% CI [0.15, 0.63]).Conclusions: For autoimmune hepatitis patients, 60 mg/d or 1 mg/kg/d of glucocorticoid gives higher biochemical remission rate and higher incidence of endpoint events and adverse events.Abbreviations: AASLD = American Association for the Study of Liver Diseases, AHRQ = Agency for Healthcare Research and Quality, AIH = autoimmune hepatitis, ALT = alanine aminotransferase, CI = confidence interval, EASL = European Association for the Study of the Liver.

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

“…In Cox's regression Corticosteroids remain the cornerstone treatment of AIH as remission rates approach 60-80%. 15,21,22 However, their beneficial effects in patients with acute and severe presentations have been a matter of debate. Our results definitively confirm that the usefulness of this treatment extends to this scenario, in which corticosteroids were found to raise transplant-free survival by 3.4-fold.…”

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

“…The evidence from China suggested that HLA-DR4 is the predominant disease-susceptible gene and clinical manifestations of those patients are milder, a lower initial dose with 0.5–1 mg/kg daily of prednisone can achieve a satisfactory response [ 1 ]. A meta-analysis of 25 studies containing 3305 patients, demonstrated that 60 mg/day or 1 mg/kg/day of glucocorticoid achieved higher levels of biochemical remission, yet also caused more side effects incidence compared with the low dose (40–50 mg/day or 0.5 mg/kg/day) group (79 vs. 72% and 42 vs. 39%, respectively) [ 224 ]. A recent European multi-center study showed that overall remission induction rates after 6 months of therapy were similar in patients treated with either high- or low-dose (≥ 0.50 vs. < 0.50 mg/kg/day, respectively) prednisone and advocated an initial low dose prednisone for the treatment of AIH [ 225 ].…”

Approach to the patient with acute severe autoimmune hepatitis

“…Although older series have reported response rates approaching 80-90% in patients with chronic AIH, newer data suggests that earlier studies overestimated biochemical remission rates, which are more likely to be in the region of 60-80% at 6 months. [92][93][94][95][96][97][98][99] In the acute severe presentation, corticosteroid response rates are more variable, i.e. 36-100%.…”