Official scientific distribution organ of Instituto Panvascular de Occidente
Evolution of a Spanish Cohort of Patients With Autoinmune Hepatitis
XML Original (Spanish)
PDF Original (Spanish)

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 Dec. 25];4(3):e12102004002. Available from: https://mail.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.

XML Original (Spanish)
PDF Original (Spanish)

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

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2020 Clinical Medicine Journal

Downloads

Download data is not yet available.