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Autoimmune hepatitis lowers quality of life regardless of remission

Patients with autoimmune hepatitis reported lower health-related quality of life compared with the general population, often related to corticosteroid use independent of remission status, according to data published in Hepatology.

Up to 50% of patients with AIH are symptomatic with fatigue, general ill health, abdominal pain, and joint pain despite treatment, according to Lin Lee Wong, MBChB, from Newcastle University in the United Kingdom, and colleagues.

“QOL is a critically-important issue for patients, and one that is increasingly prioritized by regulatory bodies when evaluating the benefits of new drugs,” Wong and colleagues wrote. “A deeper understanding of HRQOL is therefore essential if we are to make progress with therapy in AIH.”

To explore the impact of AIH and its treatment on patient life quality, the researchers evaluated 990 patients with the European Quality-of-Life 5-Dimension 5-Level (EQ-5D-5L) tool and used data to calculate health state utilities which are “fundamental in assessing cost-effectiveness and cost utility of the management of disease.”

The pain/discomfort domain had the highest proportion of patient reported outcomes (57%) and the self-care domain had the lowest (11%). Compared with the general U.K. population, EQ-5D-3L index values were significantly lower among the patients with AIH (P < .001).

Age (P < .001), BMI (P < .001), and corticosteroid use (P = .006) correlated with a lower utility index, whereas female sex (P = .027) and biochemical remission (P = .02) had higher utility index values. Additionally, patients who reported primary biliary cholangitis (P = .033), primary sclerosing cholangitis (P = .005) or rheumatoid arthritis comorbidity (P = .008) had impaired utility index compared with patients with AIH alone.

Further analysis showed that corticosteroid use correlated with increased problems in the mobility (P = .026), usual activities (P = .002), and anxiety/depression domains (P = .043).

“Health utility is a critical parameter that plays an integral role in the assessment of the value of current and emerging therapies in disease,” the researchers wrote. “Health utility in AIH should be included in the assessment of treatment approaches in AIH and improvement of health states should be a goal for future therapy approaches, alongside the conventional target of prevention of disease progression.” – by Talitha Bennett

Disclosure: Wong reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.