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Multicenter Study
. 2024 Oct;44(10):2687-2699.
doi: 10.1111/liv.16035. Epub 2024 Jul 22.

Unmet needs in autoimmune hepatitis: Results of the prospective multicentre European Reference Network Registry (R-LIVER)

Ida Schregel  1   2 , Maria Papp  2   3 , Nora Sipeki  2   3 , Patricia J Kovats  2   3   4 , Richard Taubert  2   5 , Bastian Engel  2   5 , Alejandro Campos-Murguia  2   5 , George N Dalekos  2   6 , Nikolaos Gatselis  2   6 , Kalliopi Zachou  2   6 , Piotr Milkiewicz  2   7   8 , Maciej K Janik  2   7 , Joanna Raszeja-Wyszomirska  2   7 , Henriette Ytting  2   9 , Felix Braun  1   2 , Christian Casar  1   2 , Marcial Sebode  1   2 , Ansgar W Lohse  1   2 , Christoph Schramm  1   2   10   11 ; European Reference Network (ERN) RARE‐LIVER
Affiliations
Multicenter Study

Unmet needs in autoimmune hepatitis: Results of the prospective multicentre European Reference Network Registry (R-LIVER)

Ida Schregel et al. Liver Int. 2024 Oct.

Abstract

Background and aims: The European Reference Network on Hepatological Diseases (ERN RARE-LIVER) launched the prospective, multicentre, quality-controlled R-LIVER registry on rare liver diseases. The aim of this study was to assess the presentation and outcome of autoimmune hepatitis (AIH) after 1 year of treatment.

Methods: Data were prospectively collected at the time of diagnosis and after 6 and 12 months follow-up. Complete biochemical response (CBR) was defined as normalization of alanine aminotransferase (ALT) and immunoglobulin G (IgG) serum levels.

Results: A total of 231 patients from six European centres were included in the analysis. After 6 months of treatment 50% (106/212), and after 12 months 63% (131/210) of patients reached CBR with only 27% (56/211) achieving a steroid-free CBR within the first year. Overall, 16 different treatment regimens were administered. Change of treatment, mostly due to intolerance, occurred in 30.4% within the first 6 months. In multivariate analysis, younger age at diagnosis (odds ratio [OR] = 1.03 [95% confidence interval (CI) 1.01-1.05]; p = .007), severe fibrosis (OR .38 [95% .16-.89], p = .026) and change of treatment within the first 6 months (OR .40 [95% CI .2-.86]; p = .018) were associated with a lesser chance of ALT normalization at 12 months follow-up.

Conclusion: The landscape of AIH treatment in Europe is highly heterogeneous, even between expert centres. The results from this first European multicentre prospective registry reveal several unmet needs, highlighted by the overall low rates of CBR and the frequent failure to withdraw corticosteroids.

Keywords: autoimmune hepatitis; complete biochemical response; immunosuppression; remission; treatment regime.

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References

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