Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom. Issue 9 (18th September 2018)

• Record Type: Journal Article
• Authors: Dyson, Jessica K.; Wong, Lin Lee; Bigirumurame, Theophile; Hirschfield, Gideon M.; Kendrick, Stuart; Oo, Ye H.; Lohse, Ansgar W; Heneghan, Michael A.; Jones, David E. J.
• Other Names: English Shirley investigator.; Alexander Graeme investigator.; Mells George investigator.; Majumdar Debabrata investigator.; Sathyanarayana Vinay investigator.; Ramage John investigator.; Shorrock Christopher investigator.; Maggs James investigator.; Elphick David investigator.; Macdonald Chris investigator.; Cramp Matthew investigator.; Sayer Joanne investigator.; Jupp James investigator.; Dyson Jessica investigator.; Hollywood Coral investigator.; Daley Alexandra investigator.; Corless Lynsey investigator.; Craig Darren investigator.; Collier Jane investigator.; Heneghan Michael investigator.; Misra Sharat investigator.; Corbett Chris investigator.; Dillon John investigator.; Rushbrook Simon investigator.; Lee Thomas investigator.; Sharaer Nicholas M investigator.; Rye Kara investigator.; Fowell Andrew investigator.; Broad Andrea investigator.; Mansour Dina investigator.; Douds Andy investigator.; Ryder Stephen investigator.; Keld Richard investigator.; Williams Earl investigator.; Stableforth William investigator.; Austin Andrew investigator.; Gleeson Dermot investigator.; Simpson Kenneth investigator.; Patanwala Imran investigator.; Brind Alison investigator.; de Silva Shanika investigator.; Jamil Aqueel investigator.; Singhal Saket investigator.; Ch'ng Chin Lye investigator.; Topping Joanne investigator.; Wright Mark investigator.; Valliani Talal investigator.; Jones Rebecca investigator.; Mitchison Harriet investigator.; Thorburn Douglas investigator.; Ala Aftab investigator.; Oo Ye Htun investigator.; Sakena Sushma investigator.; Porras‐Perez Francisco investigator.; Metcalf Jane investigator.; Mitchell Stephen investigator.; Unitt Esther investigator.; Gordon Victoria investigator.; Shearman Jeremy investigator.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 48:Issue 9(2018)
• Page Start: 951
• Page End: 960
• Publication Date: 2018-09-18
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.14968
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Treatment paradigms in autoimmune hepatitis (AIH) have remained largely unchanged for decades. Studies report ≤20% of patients have sub‐optimal treatment response with most requiring long‐term therapy. Aim: The United Kingdom Autoimmune Hepatitis (UK‐AIH) study was established to evaluate current treatment practice and outcomes, determine the unmet needs of patients, and develop and implement improved treatment approaches. Methods: The United Kingdom Autoimmune Hepatitis study is a cross‐sectional cohort study examining secondary care management of prevalent adult patients with a clinical diagnosis of autoimmune hepatitis. Enrolment began in March 2014. Prevalent cases were defined as having been diagnosed and treated for >1 year. Demographic data, biochemistry, treatment history and response, and care location were collected. Results: In total, 1249 patients were recruited; 635 were cared for in transplant units and 614 in non‐transplant centres (81% female with median age at diagnosis 50 years). Overall, 29 treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant compared to non‐transplant centres (62 vs 55%, P = 0.028). 55% have ongoing corticosteroid exposure; 9% are receiving prednisolone monotherapy. Those aged ≤20 years at diagnosis were more likely to develop cirrhosis and place of care was associated with an aggressive disease phenotype. Conclusions: There are significant discrepancies in the care received by patients with autoimmune hepatitis in the UK. A high proportion remains on corticosteroids and there is significant treatment variability. Patients receiving care in transplant centres were more likely to achieve and maintain remission. Overall poor remission rates suggest that there are significant unmet therapeutic needs for patients with autoimmune hepatitis.