Response to treatment of Autoimmune Hepatitis

In a retrospective study of patients with Autoimmune Hepatitis (AIH), Simon Pape and Joost Drenth, theme Renal disorders, and together with researchers of the European Reference Network RARE-LIVER, found that a rapid response to treatment, based on level of AST after 8 weeks, associates with normalization of transaminase levels in the following year. Patients with a rapid response also have a lower risk of liver-related death or transplantation than patients without this rapid response. They have published their results in 
Clinial Gastroenterology and Hepatology.

Changes in serum levels of transaminases immediately after initiation of treatment for autoimmune hepatitis (AIH) might be associated with biochemical markers of remission and liver-related events. They assessed the outcomes of patients with vs without rapid responses to treatment of AIH in a large international cohort.

A significant decrease in level of AST after 8 weeks of treatment was significantly associated with normalization of transaminase levels at 26 and 52 weeks (P<.001); a decrease of more than 80% in level of AST was associated with optimal normalization. In both cohorts, rapid responders (≥80% decrease in level of AST after 8 weeks) were more likely to achieve normalization of transaminases at 26 and 52 weeks when compared to non-rapid responders. Rapid responders in the discovery cohort had lower risk of liver-related death or transplantation (adjusted hazard ratio 0.18; 95% CI 0.05–0.63; P=.007), although this was not confirmed in the validation cohort. Results from measurement of alanine aminotransferase did not differ significantly from those of AST for the primary outcome. Slow responders (without normalization of transaminases after 1 year) had the highest risk of liver transplantation or liver-related death. Levels of aminotransferases should be monitored immediate after patients with AIH begin treatment with steroids to identify those likely to respond.