Response to immunosuppressive treatment of patients with autoimmune hepatitis
Keywords:
autoimmune hepatitis, immunosuppressants, survival.Abstract
Introduction: The response to immunosuppressive treatment in autoimmune hepatitis influences the clinical course of the disease and is associated with a longer survival.Objective: Describe the response to immunosuppressive treatment in patients with autoimmune hepatitis.
Method: A descriptive, longitudinal, ambispective study was carried out in 32 patients with autoimmune hepatitis, who received immunosuppressive treatment with response evaluation at 6 months. The variables included were: Type of autoimmune hepatitis, form of presentation, form of onset, and response to treatment. Descriptive summary measures were used: Mean and standard deviation for quantitative variables and percentage for qualitative variables. To estimate the survival function, the Kaplan-Meier curve and Log-rank were used to compare means.
Results: 71.9 % of the patients were already cirrhotic at the time of diagnosis. The 13 patients with biochemical remission, remained without progression in the current evaluation. Survival in responding patients was 100 %, while in non-responders it was 47.5 % at 10-year follow-up.
Conclusions: The response to immunosuppressive treatment has a positive impact on the non-progression of autoimmune hepatitis and was associated with greater survival.
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References
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18. Castellanos Fernández MI, Cepeda Mullo ME, la Rosa Hernández D, Vega Sánchez H, González Fabian L, Gish RG, et al. Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes. Current Therapeutic Research. 2020 [acceso: 12/11/2023]; 93:100594. Disponible en: https://www.sciencedirect.com/science/article/pii/S0011393X20300205?via%3Dihub
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20. Valera JM, Smok G, Márquez S, Poniachik J, Brahmd J. Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune. Gastroenterol Hepatol. 2011 [acceso: 12/07/2023]; 34(1): 10-15. Disponible en: https://www.elsevier .es/es-revista-gastroenterologia-hepatologia-14-articulo-regresion-histologica-fibrosis-hepatica-con-S021057051000275X
21. Pellicano R, Ferro A, Cicerchia F, Mattivi S, Fagoonee S, Durazno M. Autoimmune Hepatitis and Fibrosis. Journal of Clinical Medicine. 2023; 12 (5): 1979. DOI: https://doi.org/10.3390/jcm12051979
22. Jiang Y, Xu BH, Rodgers B, Pyr Sopoulos N. Characteristics and inpatient outcomes of primary biliary cholangitis and autoimmune hepatitis overlap syndrome. J Clin Transl Hepatol. 2021; 9(3): 392-398. DOI: https://doi.org/10.14218%2FJCTH.2021.00008
23. Toniutto P, Zorzi M, D'Alì L, Cussigh A, Cmet S, Bitetto D, et al. Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience. J Clin Med. 2023; 12(8):3008. DOI: https://doi.org/10.3390%2Fjcm12083008
24. Soloway RD, Summerskill WH, Baggenstoss AH, Geall MG, Gitnick GL, Elveback IR, et al. Clinical, biochemical, and histological remission of severe chronic active liver disease: a controlled study of treatments and early prognosis. Gastroenterology. 1972; 63(5):820-33. DOI: https://doi.org/10.1016/S0016-5085(19)33223-8
25. Biewenga M, Verhelst X, Baven-Pronk M, Putter H, van den Berg A, Colle I, et al. Dutch Autoimmune Hepatitis Study Group. Aminotransferases During Treatment Predict Long-Term Survival in Patients with Autoimmune Hepatitis Type 1: A Landmark Analysis. Clin Gastroenterol Hepatol. 2022; 20 (8): 1776-1783. DOI: https://doi.org/10.1016/j.cgh.2021.05.024
26. Hoeroldt B, McFarlane E, Dube A, Basumani P, Karajeh M, Campbell MJ, et al. Long-term outcomes of patients with autoimmune hepatitis managed at a non transplant center. Gastroenterology. 2011; 140 (7): 1980-9. DOI: https://doi.org/10.1053/j.gastro.2011.02.065
27. Van den Brand FF, van der Veen KS, de Boer YS, van Gerven NM, Lissenberg-Witte BI, Beuers U, et al. Increased Mortality Among Patients With vs Without Cirrhosis and Autoimmune Hepatitis. Clin Gastroenterol Hepatol. 2019; 17 (5): 940-947. DOI: https://doi.org/10.1016/j.cgh.2018.09.046
28. Gleeson D. Long-Term Outcomes of Autoimmune Hepatitis. Clin Liver Dis (Hoboken). 2019; 14 (1): 24-28. DOI: https://doi.org/10.1002%2Fcld.797
2. Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hematology. 2020; 72 (2): 671-722. DOI: https://doi.org/10.1002/hep.31065
3. Than NN, Jeffery HC, Oo YH. Autoimmune Hepatitis: Progress from Global Immunosuppression to Personalised Regulatory T Cell Therapy. Can J Gastroenterol Hepatol. 2016[acceso: 21/11/2023]; 2016(7181685): 1-12. Disponible en: https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4904688/pdf/CJGH2016-7181685.pdf
4. Richardson N, Ng STH, Wraith DC. Antigen-Specific Immunotherapy for Treatment of Autoimmune Liver Diseases. Front Immunol 2020; 11:1586. DOI: https://doi.org/10.3389/fimmu.2020.01586
5. Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Autoimmmune hepatitis. Cell Mol Immunol. 2022; 19 (2): 158-176. DOI: https://doi.org/10.1038/s41423-021-00768-8
6. La Rosa D, Castellanos MI. Avances en la inmunopatogenia de la hepatitis autoinmune. Revista Habanera de Ciencias Médicas. 2022 [acceso: 13/07/2023]; 21 (2): e4411. Disponible en: https://revhabanera.sld.cu/index.php/rhab/article/view/4411
7. Hartl J, Ehlken H, Sebode M, Peiseler M, Krech T, Zenouzi R, et al. Usefulness of biochemical remisión and transient elastography in monitoring disease course in autoimmune hepatitis. J Hepatol. 2018; 68 (4): 754-763. DOI: https://doi.org/10.1016/j.jhep.2017.11.020
8. PapeS, Gevers TG, Vrolik JM, Hoek B, Bouma G, Nieuwkerk CM. Rapid Response to Treatment of Autoimmune Hepatitis Associated With Remission at 6 and 12 Months. Clinical Gastroenterology and Hepatology. 2020; 18 (7): 1609-1617. DOI: https://doi.org/10.1016/j.cgh.2019.11.013
9. Li Y, Xiao X, Miao Q, Ma X. Rapid response predicts complete biochemical response and histological remission in autoimmune hepatitis. J Hepatol. 2022; 77 (5): 1463-1464. DOI: https://doi.org/10.1016/j.jhep.2022.07.012
10. Cruz ZD, Samada M, Rodríguez H, Pérez T Perera JC, Chao L. Impacto de la etiología de la cirrosis hepática en la evolución clínica. Revista Hospital Juárez de México. 2021; 87 (4): 1-7. DOI: http://dx.doi.org/10.24875/RHJM. 20000065
11. Rodríguez H, Samada M, Hernández JC, Pérez T, Hernández Z, Chao L. Evolución de pacientes con hepatitis autoinmune después de tratamiento. Investigaciones Medicoquirúrgicas. 2016 [acceso: 05/07/2023]; 8 (1): 4-13. Disponible en: https://revcimeq.sld.cu/index.php/imq/article/view/333
12. Hennes EM, Zeniya M, Czaja AJ, Parés A, Dalekos GN, Krawitt EL, et al. International Autoimmune Hepatitis Group. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008; 48 (1): 169-76. DOI: https://doi.org/10.1002/hep.22322
13. Marino P M. Novedades en hepatitis autoinmune. Acta Gastroenterol Latinoam. 2023; [acceso:13/07/2023];53(1):28-37. Disponible en: https://actagastro.org/numeros-anteriores/2023/Vol-53-N1/Vol53N1-PDF06.pdf
14. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996 [acceso:13/07/2023]; 24 (2): 289-93. Disponible en: https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.100 2/hep.510240201
15. Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos. AMM; 2013 [acceso: 21/11/2023]. Disponible en: https://uchile.cl/dam/jcr:fe1a556e-69c7-4ab9-881a-a0fcae203cfe/declaracin-de-helsinki -2013.pdf
16. Díaz Ramírez GS, Jiménez D, Escobar D, Vargas C, Rojas C, Rojas N. Characterization of patients diagnosed with autoimmune hepatitis in a fourth level hospital from Cali, 2014-2020. Revista. colomb. Gastroenterol. 2023 [acceso: 21/11/2023]; 38 (1): 2-11. Disponible en: https://revistagastrocol.com/index.php/rcg/article/view/907/1515
17. Sharma S, Agarwal S, Kaushal K, Anand A, Gunjan D, Yadav R, et al. Presence and type of decompensation affects outcomes in autoimmune hepatitis upon treatment with corticosteroids. JGH Open. 2020; 5(1):81-90. DOI: https://doi.org/10.1002%2Fjgh3.12451
18. Castellanos Fernández MI, Cepeda Mullo ME, la Rosa Hernández D, Vega Sánchez H, González Fabian L, Gish RG, et al. Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes. Current Therapeutic Research. 2020 [acceso: 12/11/2023]; 93:100594. Disponible en: https://www.sciencedirect.com/science/article/pii/S0011393X20300205?via%3Dihub
19. Strassburg MD CP, Manns MP Therapy of autoimmune hepatitis.Best Practice & Research Clinical Gastroenterology. 2011 [acceso: 12/11/2023]; 25(6): 673687. Disponible en: https://www.sciencedirect .com/science/article/abs/pii/S152169181100 0849
20. Valera JM, Smok G, Márquez S, Poniachik J, Brahmd J. Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune. Gastroenterol Hepatol. 2011 [acceso: 12/07/2023]; 34(1): 10-15. Disponible en: https://www.elsevier .es/es-revista-gastroenterologia-hepatologia-14-articulo-regresion-histologica-fibrosis-hepatica-con-S021057051000275X
21. Pellicano R, Ferro A, Cicerchia F, Mattivi S, Fagoonee S, Durazno M. Autoimmune Hepatitis and Fibrosis. Journal of Clinical Medicine. 2023; 12 (5): 1979. DOI: https://doi.org/10.3390/jcm12051979
22. Jiang Y, Xu BH, Rodgers B, Pyr Sopoulos N. Characteristics and inpatient outcomes of primary biliary cholangitis and autoimmune hepatitis overlap syndrome. J Clin Transl Hepatol. 2021; 9(3): 392-398. DOI: https://doi.org/10.14218%2FJCTH.2021.00008
23. Toniutto P, Zorzi M, D'Alì L, Cussigh A, Cmet S, Bitetto D, et al. Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience. J Clin Med. 2023; 12(8):3008. DOI: https://doi.org/10.3390%2Fjcm12083008
24. Soloway RD, Summerskill WH, Baggenstoss AH, Geall MG, Gitnick GL, Elveback IR, et al. Clinical, biochemical, and histological remission of severe chronic active liver disease: a controlled study of treatments and early prognosis. Gastroenterology. 1972; 63(5):820-33. DOI: https://doi.org/10.1016/S0016-5085(19)33223-8
25. Biewenga M, Verhelst X, Baven-Pronk M, Putter H, van den Berg A, Colle I, et al. Dutch Autoimmune Hepatitis Study Group. Aminotransferases During Treatment Predict Long-Term Survival in Patients with Autoimmune Hepatitis Type 1: A Landmark Analysis. Clin Gastroenterol Hepatol. 2022; 20 (8): 1776-1783. DOI: https://doi.org/10.1016/j.cgh.2021.05.024
26. Hoeroldt B, McFarlane E, Dube A, Basumani P, Karajeh M, Campbell MJ, et al. Long-term outcomes of patients with autoimmune hepatitis managed at a non transplant center. Gastroenterology. 2011; 140 (7): 1980-9. DOI: https://doi.org/10.1053/j.gastro.2011.02.065
27. Van den Brand FF, van der Veen KS, de Boer YS, van Gerven NM, Lissenberg-Witte BI, Beuers U, et al. Increased Mortality Among Patients With vs Without Cirrhosis and Autoimmune Hepatitis. Clin Gastroenterol Hepatol. 2019; 17 (5): 940-947. DOI: https://doi.org/10.1016/j.cgh.2018.09.046
28. Gleeson D. Long-Term Outcomes of Autoimmune Hepatitis. Clin Liver Dis (Hoboken). 2019; 14 (1): 24-28. DOI: https://doi.org/10.1002%2Fcld.797
Published
2024-02-01
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Rodríguez Rodríguez H, Samada Suárez M, Pérez González T, Barroso Márquez L, Cruz Hernández ZD, Tusen Toledo Y, et al. Response to immunosuppressive treatment of patients with autoimmune hepatitis. Rev Cubana Med Milit [Internet]. 2024 Feb. 1 [cited 2025 Apr. 2];53(1):e024017849. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/17849
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