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. 2021 Jul;41(7):1592-1599.
doi: 10.1111/liv.14900. Epub 2021 May 11.

Autoimmune hepatitis in patients aged 70 years or older: Disease characteristics, treatment response and outcome

George N Dalekos  1   2 , Kalliopi Azariadis  1 , Vasiliki Lygoura  1 , Pinelopi Arvaniti  1 , Stella Gampeta  1 , Nikolaos K Gatselis  1   2
Affiliations

Autoimmune hepatitis in patients aged 70 years or older: Disease characteristics, treatment response and outcome

George N Dalekos et al. Liver Int. 2021 Jul.

Abstract

Background & aims: Autoimmune hepatitis (AIH) affects both sexes and all age groups. However, very few studies have focused specifically on the characteristics and outcome of AIH in patients aged 70 y or older.

Methods: 25/234 patients with well-established AIH and disease onset at ≥70-y (median: 73-y) were analysed and compared to the rest patients (median: 47 y). Treatment response was assessed in all patients from both groups who were eligible for treatment (n = 202).

Results: Disease presentation was mainly insidious in both groups (19/25, 76% vs. 134/209, 64.1%; P = .313). At diagnosis, older patients had lower alaninoaminotrasferase (101[433] vs. 199[441] IU/L, P < .05) but were more frequently cirrhotic (12/25, 48% vs. 57/209, 27.3%; P = .03). Importantly, similar rates of on-treatment response (16/18, 89% vs. 154/184, 84%; P = .565), corticosteroid withdrawal (10/16, 62.5% vs. 113/154, 73.4%; P = .355) and complete withdrawal of immunosuppression (1/16, 6.3% vs. 40/154, 26%; P = .122) were achieved in both groups. Treatment-related adverse events were evenly observed between groups (6/18, 33% vs. 54/184, 29%; P = .724). In treated patients, the age ≥70 y was only associated with the overall mortality (HR 8.3 [95% CI: 2.1-36.4], P = .003), but not with the liver-related mortality (HR 3.4 [95% CI: 0.4-30.0], P = .268).

Conclusion: AIH should be seriously considered in patients ≥70 y with unexplained impaired liver function tests as the disease is not infrequent in this group and seems to bear an increased risk for advanced disease stage at diagnosis. However, if immunosuppression is started promptly, it seems as safe and effective as in younger patients.

Keywords: aged; autoimmune hepatitis; immunosuppression; older age.

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References

REFERENCES

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