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Aliment Pharmacol Ther. 2017 Mar;45(5):723-732. doi: 10.1111/apt.13907. Epub 2016 Dec 22.

Expert clinical management of autoimmune hepatitis in the real world.

Author information

1
London, UK.
2
Amsterdam, The Netherlands.
3
Málaga, Spain.
4
Larissa, Greece.
5
Padova, Italy.
6
Sheffield, UK.
7
Birmingham, UK.
8
Milan, Italy.
9
Bologna, Italy.
10
Hamburg, Germany.
11
Porto, Portugal.
12
Warsaw, Poland.
13
Lugano, Switzerland.
14
Leiden, The Netherlands.
15
Houston, TX, USA.

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.

PMID:
28004405
DOI:
10.1111/apt.13907
[Indexed for MEDLINE]
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