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'Wide variation' in management of autoimmune hepatitis

The management of patients with autoimmune hepatitis varies widely, even among expert hepatologists, according to the results of a recent survey.

Despite recently published guidelines, “expert opinion rather than evidence-based medicine remains a factor in the management of patients with AIH,” investigators wrote. “The present study was designed to explore the current practices on the management of AIH of a panel comprising international expert hepatologists with extensive experience in AIH in order to help design and inform future prospective studies.”

A total of 37 members of the International AIH Group, representing 18 countries and five continents, completed a survey questionnaire consisting of four clinical scenarios on different presentations of AIH.

The study researchers highlighted the following survey results:

• No respondents used budesonide as a first line induction agent for acute presentation of AIH;
• 14% used thiopurine S-methyltransferase measurements before beginning thiopurine maintenance therapy;
• 35% performed routine liver biopsy at 2 years of biochemical remission;
• 11% reduced azathioprine and 27% attempted withdrawal when histological inflammatory activity was absent;
• mycophenolate mofetil was the most common second-line agent for difficult-to-treat patients compared with tacrolimus and ciclosporin, which were used less often; and
• one center had extensive experience with Remicade (infliximab, Janssen) and seven centers had tried rescue therapy with rituximab.

“This survey shows that predniso(lo)ne remains the preferred agent for induction of remission in newly diagnosed patients with AIH. Moreover, there is a lack of consensus among expert hepatologists regarding both the initial management and follow-up of patients with AIH,” the investigators wrote. “In addition, and despite the lack of good quality evidence, there is considerable experience within the field albeit largely unreported in relation to second- and third-line therapies for difficult-to-treat AIH patients.” – by Adam Leitenberger

Disclosures: One of the researchers reports he is supported by the National Institute of Health Research Birmingham Liver Biomedical Research Unit.