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Ongoing Histological Activity With Autoimmune Hepatitis Reduced Long-Term Survival
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In a new study, persisting histological activity was prevalent among patients with autoimmune hepatitis who achieved biochemical remission after immunosuppressive therapy and reduced long-term survival.
“The main finding of this study, and a novel observation, is that, in treated patients with [autoimmune hepatitis], persisting histological activity despite biochemical remission is an independent risk factor for reduced long-term transplant-free survival,” the researchers wrote. “These patients have an increased risk of death from liver disease, whereas patients who attain histological remission have no such increase.”
Researchers, including Dermot Gleeson, MD, BSc, FRCP, Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, United Kingdom, analyzed data from 120 patients with autoimmune hepatitis (AIH) who underwent immunosuppressive therapy and follow-up biopsy at least 6 months after sustained biochemical remission at Sheffield Teaching Hospital.
Of the 120 patients, 55 had persisting histological activity, according to data from the Ishak histological activity index. Patients with persisting activity had higher alanine aminotransferase levels compared with patients who achieved histological remission (24 vs. 18 IU/l, P = .003) and higher aspartate transaminase levels compared with patients who achieved histological remission (27 vs. 23 IU/l, P = .03) at follow-up biopsy.
In addition, patients with persisting histological activity had a lower regression rate of fibrosis at follow-up biopsy compared with patients who achieved histological remission (32% vs. 60%, P = .004) and had higher rate of mortality due to liver disease (standardized mortality ratio 1.4 vs. 0.7, P < .05).
Multivariate analysis showed that persisting histological activity was independently associated with all-cause death and transplantation (HR = 3.1; 95% CI, 1.2-8.1); P = .02) and liver-related death and transplantation, despite no significance (HR = 9.7; 95% CI, 0.84-111.6; P = .07).
“Despite the necessary caveats because our study is retrospective, our results suggest, first, that confirmation of histological remission in treated AIH requires a follow-up liver biopsy,” the researchers wrote. “Second, the current standard treatment regime we used failed to induce histological remission in 48% of patients who had achieved biochemical remission.
“Finally, these patients were less likely to achieve improvement in liver fibrosis and had significantly higher long-term mortality. If this observation is confirmed, histological remission should be the aim of treatment in AIH.” – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.
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