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Evolution of a Spanish Cohort of Patients With Autoinmune Hepatitis
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Keywords

autoimmune hepatitis
prognostic factors
natural history

How to Cite

1.
Evolution of a Spanish Cohort of Patients With Autoinmune Hepatitis. Rev Med Clin [Internet]. 2020 Oct. 12 [cited 2024 Nov. 23];4(3):e12102004002. Available from: https://medicinaclinica.org/index.php/rmc/article/view/312

Abstract

Introduction: There is slight evidence about natural history of autoimmune hepatitis and its management in a real setting in Spain. Aim: To assess the evolution in clinical practice of patients with AIH and analyse the prognostic factors related to it. Methods: All patients with AIH diagnosed in our hospital from January 2000 to December 2018 were included. Results: 84 patients (77% women; age 51,9 years (SD:17) were included, with a prevalence of 22 cases/100.000 inhabitants and a incidence of 1.2 annual cases/100.000 inhabitants. At the time of diagnosis 15% of them had cirrhosis. After induction treatment 70,2% of them reached biochemical remission with a mean of 190 days. About 38% patients required second line treatment, being 40% of them with mycophenolate mofetil. The reason of treatment change was 84% due to side effects, 9% because of inefficacy and 7% owing to a better side-effects profile. Treatment was interrupted in 24 patients (28%) because of biochemical remission after a mean time of treatment of 5,8 years (SD 38 years) with a posterior relapse of 45,8%.  No patient required hepatic transplantation and only one patient died because of a variceal bleeding. No significant prognostic factors related to AIH evolution were found. Conclusion: In our reference area the prevalence of AIH was 22 cases/100.000 inhabitants. Biochemical remission was reached in most of our patients. However one third of them required a change in treatment strategy, mainly due to side effects related to azathioprine. No significant prognostic factors related to AIH evolution were found.

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References

Lohse AW, Chazouillères O, Dalekos G, Drenth J, Heneghan M, Hofer H, et al. EASL clinical practice guidelines: Autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004, http://dx.doi.org/10.1016/j.jhep.2015.06.030

Ngu JH, Bechly K, Chapman BA, Burt MJ, Barclay ML, Gearry RB, et al. Population-based epidemiology study of autoimmune hepatitis: A disease of older women? J Gastroenterol Hepatol. 2010;25(10):1681–6, https://doi.org/10.1111/j.1440-1746.2010.06384.x

Boberg KM. Prevalence and Epidemiology of Autoimmune hepatitis. Clin Liver Dis. 2002;6(1089):635–47, https://doi.org/10.1016/S1089-3261(02)00021-1

Grønbæk L, Vilstrup H, Jepsen P. Autoimmune hepatitis in Denmark: Incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. J Hepatol. 2014;60(3):612–7, https://doi.org/10.1016/j.jhep.2013.10.020

Muratori P, Lalanne C, Bianchi G, Lenzi M, Muratori L. Predictive factors of poor response to therapy in Autoimmune Hepatitis. Dig Liver Dis. 2016;48(9):1078–81, http://dx.doi.org/10.1016/j.dld.2016.06.018

Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354(1):54–66, https://doi.org/10.1056/nejmra050408

Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: Review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929–38, https://doi.org/10.1016/S0168-8278(99)80297-9

Hennes EM, Zeniya M, Czaja AJ, Parés A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169–76, https://doi.org/10.1002/hep.22322

Liberal R, de Boer YS, Andrade RJ, Bouma G, Dalekos GN, Floreani A, et al. Expert clinical management of autoimmune hepatitis in the real world. Aliment Pharmacol Ther. 2017;45(5):723–32, https://doi.org/10.1111/apt.13907

Sandusadee N, Sukeepaisarnjaroen W, Suttichaimongkol T. Prognostic factors for remission, relapse, and treatment complications in type 1 autoimmune hepatitis. Heliyon. 2020;6(4):e03767, https://doi.org/10.1016/j.heliyon.2020.e03767

Arcos-Machancoses JV, Molera Busoms C, Julio Tatis E, Bovo MV, Quintero Bernabeu J, Juampérez Goñi J, et al. Development and validation of a new simplified diagnostic scoring system for pediatric autoimmune hepatitis. Dig Liver Dis. 2019;51(9):1308–13, https://doi.org/10.1016/j.dld.2019.02.018

Llovet LP, Horta D, Eliz MG, Berenguer M, Fábrega E, Sáez-Royuela F, et al. Presentation and Outcomes of Pregnancy in Patients With Autoimmune Hepatitis. Clin Gastroenterol Hepatol. 2019;17(13):2819–21. https://doi.org/10.1016/j.cgh.2018.12.030

Johnson PJ, McFarlane IG. Meeting report: International autoimmune hepatitis group. Hepatology. 1993;18(4):998–1005, https://doi.org/10.1002/hep.1840180435

Lee YM, Teo EK, Ng TM, Khor C, Fock KM. Autoimmune hepatitis in Singapore: A rare syndrome affecting middle-aged women. J Gastroenterol Hepatol. 2001;16(12):1384–9, https://doi.org/10.1046/j.1440-1746.2001.02646.x

Hurlburt KJ, McMahon BJ, Deubner H, Hsu-Trawinski B, Williams JL, Kowdley KV. Prevalence of autoimmune liver disease in Alaska Natives. Am J Gastroenterol. 2002;97(9):2402-2407, PMID: 12358264

Primo J, Merino C, Fernández J, Molés JR, Llorca P, Hinojosa J. Incidencia y prevalencia de hepatitis autoinmune en el área sanitaria del Hospital de Sagunto. Gastroenterol Hepatol. 2004;27(4):239–43, http://dx.doi.org/10.1016/S0210-5705(03)70452-X

Primo J, Maroto N, Martínez M, et al. Incidence of adult form of autoimmune hepatitis in Valencia (Spain). Acta Gastroenterol Belg. 2009;72(4):402-6, PMID: 20163033

García-Torres ML, Primo J, Ortuño JA, et al. Estudio clínico de la hepatitis autoinmune del adulto en Valencia. Rev Esp Enferm Dig. 2008;100(7):400-4, https://doi.org/10.4321/s1130-01082008000700004

Doycheva I, Watt KD, Gulamhusein AF. Autoimmune hepatitis: Current and future therapeutic options. Liver Int. 2019;39(6):1002-13, https://doi.org/10.1111/liv.14062

Werner M, Prytz H, Ohlsson B, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study. Scand J Gastroenterol. 2008;43(10):1232-1240, https://doi.org/10.1080/00365520802130183

Feld JJ, Dinh H, Arenovich T, Marcus VA, Wanless IR, Heathcote EJ. Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome. Hepatology. 2005;42(1):53-62, https://doi.org/10.1002/hep.20732

Yeoman AD, Al-Chalabi T, Karani JB, et al. Evaluation of risk factors in the development of hepatocellular carcinoma in autoimmune hepatitis: Implications for follow-up and screening. Hepatology. 2008;48(3):863-870, https://doi.org/10.1002/hep.22432

Pratt DS, Flavin DP, Kaplan MM. The successful treatment of autoimmune hepatitis with 6-mercaptopurine after failure with azathioprine. Gastroenterology. 1996;110(1):271-4, https://doi.org/10.1053/gast.1996.v110.pm8536867

Santiago P, Schwartz I, Tamariz L, Levy C. Systematic review with meta-analysis: mycophenolate mofetil as a second-line therapy for autoimmune hepatitis. Aliment Pharmacol Ther. 2019;49(7):830-9, https://doi.org/10.1111/apt.15157

Czaja AJ, Freese DK; American Association for the Study of Liver Disease. Diagnosis and treatment of autoimmune hepatitis. Hepatology. 2002;36(2):479-497, https://doi.org/10.1053/jhep.2002.34944

Hartl J, Ehlken H, Weiler-Normann C, Sebode M, Kreuels B, Pannicke N, et al. Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis. J Hepatol. 2015;62(3):642–6, http://dx.doi.org/10.1016/j.jhep.2014.10.018

Guirguis J, Alonso Y, Lopez R, Carey W. Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance. Gastroenterol Rep (Oxf). 2018;6(4):284-290, https://doi.org/10.1093/gastro/goy020

Teufel A, Weinmann A, Kahaly GJ, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol. 2010;44(3):208-213, https://doi.org/10.1097/mcg.0b013e3181c74e0d

De Luca-Johnson J, Wangensteen KJ, Hanson J, Krawitt E, Wilcox R. Natural History of Patients Presenting with Autoimmune Hepatitis and Coincident Nonalcoholic Fatty Liver Disease. Dig Dis Sci. 2016;61(9):2710-20, https://doi.org/10.1007/s10620-016-4213-3

Takahashi A, Arinaga-Hino T, Ohira H, et al. Non-alcoholic fatty liver disease in patients with autoimmune hepatitis. JGH Open. 2018;2(2):54-8, https://doi.org/10.1002/jgh3.12046

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