Early normalisation of aminotransferase predicts complete biochemical remission in autoimmune hepatitis patients

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Sirs, We read with interest the review of Yeoman et al., which summarised the latest evidence regarding the therapy and long-term management of autoimmune hepatitis (AIH).1 More recently, in the updated AASLD guideline for AIH, the definition of complete remission has been modified to the normalisation of aminotransferases and immunoglobulin G (IgG)/γ-globulins.2 In addition to complete remission, the duration of remission induction may also be important for prognosis in patients with AIH.3

A retrospective evaluation of 115 consecutive Chinese patients with AIH was performed to determine treatment response times and complete biochemical remission rates. The complete biochemical remission rate was 69% with 24 months of immunosuppressive therapy (prednisolone alone or prednisolone in combination with azathioprine) and 87% with 36 months of therapy. Mean duration of remission was 20.3 months (95% CI 17.8–22.8 months).

Factors independently associated with unsatisfactory response to treatment were concurrent immune diseases (OR 7.16, 95% CI 2.06–24.87, P = 0.002); MELD scores (onset) (OR 1.35, 95% CI 1.14–1.60, P = 0.001) and histological biliary changes (OR 5.73, 95% CI 1.01–32.45, P = 0.049). The cumulative remission rates were estimated in the 81 patients with normal aminotransferase levels at 3 months (Group 1) and the 34 patients whose levels remained abnormal (Group 2). The 2-year remission rate was 86% for Group 1 vs. 27% for Group 2 (P < 0.001). The hazard ratio for Group 1 vs. Group 2 was 5.87 (95% CI 3.02–11.39) (Figure 1).

Figure 1.

 Estimated cumulative rate of complete biochemical remission in patients with or without remission at 3 months. Group 1: patients whose aminotransferase levels had normalised within 3 months (n = 81). Group 2: patients whose aminotransferase levels remained abnormal at 3 months (n = 34). The 2-year remission rate for Group 1 was 86% vs. 27% for Group 2 (P < 0.001). The hazard ratio for Group 1 vs. Group 2 was 5.87 (95% CI 3.02–11.39).

Our previous study showed that the original revised criteria and the simplified criteria both had good diagnostic accuracy in Chinese adult patients with AIH.4 In this study, a good response to corticosteroid treatment was demonstrated for the first time in Chinese patients with AIH. Normalisation of serum aminotransferase within 3 months of starting therapy has predictive value for complete biochemical remission at 2 years in these patients.

Acknowledgements

Declaration of personal interests: None. Declaration of funding interests: This work was supported by the Awards from the National Natural Science Foundation of China (#30770963 and #30972751) (X.M.), Renji Hospital Research Program for Youth Researcher (RJPY10-002) (Q.W.), Shanghai Pujiang Program (X.M.) and the Program of Shanghai Innovative Research Team in Immunity of Non-viral Liver Diseases (X.M.).

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