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Long‐term clinical outcomes in patients with autoimmune hepatitis according to treatment response in Asian country
Author(s) -
Choi Jonggi,
Choi Gwang Hyeon,
Lee Danbi,
Shim Ju Hyun,
Lim YoungSuk,
Lee Han Chu,
Chung YoungHwa,
Lee YungSang,
Kim Kang Mo
Publication year - 2019
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14082
Subject(s) - autoimmune hepatitis , medicine , term (time) , immunology , hepatitis , intensive care medicine , physics , quantum mechanics
Background & Aims As surrogate markers for autoimmune hepatitis (AIH), serum alanine aminotransferase (ALT) and immunoglobulin G (IgG) are convenient to measure under immunosuppression. However, the long‐term prognosis of patients who achieve complete biochemical remission (CBR) in comparison with patients who achieve only biochemical remission (BR) is uncertain. Methods A total of 291 patients (89.7% female) diagnosed with AIH were retrospectively reviewed. CBR was defined as normal ALT and IgG levels with immunosuppression, while BR was defined as normal ALT levels. CBR was further divided into early CBR (<1year) and late CBR (≥1year) by the timing of remission. Liver‐related adverse outcomes including liver‐related death, liver transplantation and hepatocellular carcinoma were evaluated. Results With immunosuppressive treatment, 222 (76.3%) patients achieved CBR (early CBR: 168 and late CBR: 54). BR was achieved in 55 (18.9%) patients and 14 (4.8%) patients remained non‐remission. With a median follow‐up duration of 6.6 years, the risk of liver‐related mortality was the lowest in patients with CBR, followed by patients with late CBR, BR and non‐response. The cumulative risk of liver‐related adverse outcomes was the highest in patients with non‐response (8.51/100 person‐years [PYs]), followed by BR (1.95/100 PYs), late CBR (1.89/100 PYs) and early CBR (0.75/100 PYs). By multivariable analysis, age, cirrhosis and treatment responses were independently associated with liver‐related adverse outcomes. Conclusions Patients with CBR within 1 year after treatment initiation had the lowest risk of liver‐related adverse outcomes. Patients with late CBR and those with only BR had a comparable risk of long‐term outcomes.