Expert clinical management of autoimmune hepatitis in the real world

R Liberal, Y S de Boer, R J Andrade, G Bouma, G N Dalekos, A Floreani, D Gleeson, Gideon Hirschfield, P Invernizzi, M Lenzi, A W Lohse, G Macedo, P Milkiewicz, B Terziroli, B van Hoek, J M Vierling, M A Heneghan, International Autoimmune Hepatitis Group (IAIHG)

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)

Abstract

BACKGROUND: High-quality data on the management of autoimmune hepatitis (AIH) are scarce. Despite published guidelines, management of AIH is still expert based rather than evidence based.

AIM: To survey expert hepatologists, asking each to describe their practices in the management of patients with AIH.

METHODS: A survey questionnaire was distributed to members of the International AIH Group. The questionnaire consisted of four clinical scenarios on different presentations of AIH.

RESULTS: Sixty surveys were sent, out of which 37 were returned. None reported budesonide as a first line induction agent for the acute presentation of AIH. Five (14%) participants reported using thiopurine S-methyltransferase measurements before commencement of thiopurine maintenance therapy. Thirteen (35%) routinely perform liver biopsy at 2 years of biochemical remission. If histological inflammatory activity is absent, four (11%) participants reduced azathioprine, whereas 10 (27%) attempted withdrawal altogether. Regarding the management of difficult-to-treat patients, mycophenolate mofetil is the most widely used second-line agent (n = ~450 in 28 centres), whereas tacrolimus (n = ~115 in 21 centres) and ciclosporin (n = ~112 in 18 centres) are less often reported. One centre reported considerable experience with infliximab, while rescue therapy with rituximab has been tried in seven centres.

CONCLUSIONS: There is a wide variation in the management of patients with autoimmune hepatitis even among the most expert in the field. Although good quality evidence is lacking, there is considerable experience with second-line therapies. Future prospective studies should address these issues, so that we move from an expert- to an evidence- and personalised-based care in autoimmune hepatitis.

Original languageEnglish
Pages (from-to)723-732
Number of pages10
JournalAlimentary Pharmacology & Therapeutics
Volume45
Issue number5
Early online date22 Dec 2016
DOIs
Publication statusPublished - Mar 2017

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