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Multicenter Study
. 2018 Nov;48(9):951-960.
doi: 10.1111/apt.14968. Epub 2018 Sep 18.

Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom

Jessica K Dyson  1   2 , Lin Lee Wong  1   2 , Theophile Bigirumurame  3 , Gideon M Hirschfield  4 , Stuart Kendrick  5 , Ye H Oo  4 , Ansgar W Lohse  6 , Michael A Heneghan  7 , David E J Jones  1   2 ; UK-AIH Consortium
Collaborators, Affiliations
Multicenter Study

Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom

Jessica K Dyson et al. Aliment Pharmacol Ther. 2018 Nov.

Abstract

Background: Treatment paradigms in autoimmune hepatitis (AIH) have remained largely unchanged for decades. Studies report ≤20% of patients have sub-optimal treatment response with most requiring long-term therapy.

Aim: The United Kingdom Autoimmune Hepatitis (UK-AIH) study was established to evaluate current treatment practice and outcomes, determine the unmet needs of patients, and develop and implement improved treatment approaches.

Methods: The United Kingdom Autoimmune Hepatitis study is a cross-sectional cohort study examining secondary care management of prevalent adult patients with a clinical diagnosis of autoimmune hepatitis. Enrolment began in March 2014. Prevalent cases were defined as having been diagnosed and treated for >1 year. Demographic data, biochemistry, treatment history and response, and care location were collected.

Results: In total, 1249 patients were recruited; 635 were cared for in transplant units and 614 in non-transplant centres (81% female with median age at diagnosis 50 years). Overall, 29 treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant compared to non-transplant centres (62 vs 55%, P = 0.028). 55% have ongoing corticosteroid exposure; 9% are receiving prednisolone monotherapy. Those aged ≤20 years at diagnosis were more likely to develop cirrhosis and place of care was associated with an aggressive disease phenotype.

Conclusions: There are significant discrepancies in the care received by patients with autoimmune hepatitis in the UK. A high proportion remains on corticosteroids and there is significant treatment variability. Patients receiving care in transplant centres were more likely to achieve and maintain remission. Overall poor remission rates suggest that there are significant unmet therapeutic needs for patients with autoimmune hepatitis.

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Figures

Figure 1
Figure 1
Age at diagnosis in 20 y age brackets for whole cohort (n = 1249), n (%). Patients were categorised according to age at diagnosis; 0‐20 years, 21‐40 y, 41‐60 y, 61‐80 y, 81 y and over
Figure 2
Figure 2
Breakdown of patients by remission status according to simplified drug combinations (excluding transplant patients). CNI: calcineurin inhibitor
See this image and copyright information in PMC

Comment in

  • Editorial: "real world data" of AIH-time to connect!
    Hupa-Breier KL, Taubert R, Jaeckel E, Manns MP. Hupa-Breier KL, et al. Aliment Pharmacol Ther. 2018 Dec;48(11-12):1315-1316. doi: 10.1111/apt.15028. Aliment Pharmacol Ther. 2018. PMID: 30488627 No abstract available.

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