Prompt initiation of high‐dose i.v. corticosteroids seems to prevent progression to liver failure in patients with original acute severe autoimmune hepatitis. Issue 1 (18th October 2018)

• Record Type: Journal Article
• Authors: Zachou, Kalliopi; Arvaniti, Pinelopi; Azariadis, Kalliopi; Lygoura, Vasiliki; Gatselis, Nikolaos K.; Lyberopoulou, Aggeliki; Koukoulis, George K.; Dalekos, George N.
• Is Part Of: Hepatology research. Volume 49:Issue 1(2019)
• Page Start: 96
• Page End: 104
• Publication Date: 2018-10-18
• Subjects: acute liver failure -- autoimmune hepatitis -- azathioprine -- corticosteroid -- liver transplantation -- mycophenolate mofetil; Liver -- Diseases -- Periodicals; Liver Diseases -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1111/hepr.13252
• Languages: English
• ISSNs: 1386-6346

Abstract

Abstract : Aims: The definition of original acute severe autoimmune hepatitis (AS‐AIH) is unclear. However, its rapid recognition and early treatment is potentially life‐saving. Therefore, we present herein an open, real‐world observational study for the assessment of the efficacy and safety of early high‐dose i.v. corticosteroids in original AS‐AIH patients. Methods: Prospectively collected data from 184 AIH patients were analyzed retrospectively. Original AS‐AIH defined as an acute symptomatic presentation of newly diagnosed AIH (transaminases >10× upper limit of normal, bilirubin >4 mg/dL, and international normalized ratio [INR] ≥1.5) without histological lesions of chronic disease. Results: Thirty‐four of 184 (18.5%) patients had original AS‐AIH. These patients were promptly treated with i.v. corticosteroids (either 1 g methylprednisolone for 3 consecutive days followed by i.v. 1 mg/kg/day prednisolone or i.v. 1.5 mg/kg/day prednisolone from the beginning). Only 1/34 (2.9%) died due to sepsis; none required liver transplantation during follow‐up (65 [1–175] months). No significant differences were detected in baseline characteristics between original AS‐AIH patients and those with insidious presentation (not‐AS‐AIH; n = 117) apart from antinuclear antibodies negativity ( P = 0.038), and higher immunoglobulin G, transaminases, INR, and bilirubin in original AS‐AIH patients ( P = 0.001 for all). Complete response and corticosteroids withdrawal (for patients treated >12 months) were significantly more frequent in original AS‐AIH ( n = 28) than in not‐AS‐AIH ( n = 79; P = 0.026 and P = 0.016, respectively). Presence of original AS‐AIH was the only independent predictor for achieving complete response. Conclusions: Prompt initiation of high‐dose i.v. corticosteroids in original AS‐AIH seems safe and efficient as it prevents disease deterioration and the need for liver transplantation. The long‐term overall survival of these patients was high (97% for 5.3 years), and the long‐term treatment response and corticosteroids withdrawal rates were higher compared to not‐AS‐AIH patients.