Adverse events related to low dose corticosteroids in autoimmune hepatitis

Abstract

Summary Background Autoimmune hepatitis requires long‐term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long‐term studies are mainly derived from studies in rheumatic diseases. Aim To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long‐term maintenance treatment of patients with autoimmune hepatitis. Methods We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results A total of 6634 years, with a median of 13 (range 1‐40) per patient were recorded. The median age at diagnosis was 44 years (range 2‐88). Adverse events were documented in 120 (25%) patients. Low‐dose predniso(lo)ne (0.1‐5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.

Bone microarchitecture in patients with autoimmune hepatitis

“…A severe extrahepatic complication of autoimmune liver diseases is systemic bone loss (i.e., osteoporosis) accompanied by an increased risk for fragility fractures (11)(12)(13)(14)(15) . We recently performed a dual-energy X-ray absorptiometry (DXA) study in a large cohort of 211 AIH patients in which we detected an osteoporosis prevalence of 19.2% for patients older than 50 years (15) .…”

“…(4) A severe extrahepatic complication of autoimmune liver diseases is systemic bone loss (i.e., osteoporosis) accompanied by an increased risk for fragility fractures. (11)(12)(13)(14)(15) We recently performed a dual-energy x-ray absorptiometry (DXA) study in a large cohort of 211 AIH patients in which we detected an osteoporosis prevalence of 19.2% for patients older than 50 years. (15) We identified independent risk factors for osteoporosis, such as prolonged glucocorticoid use >90 months, body mass index (BMI) < 23 kg/m 2 , and liver fibrosis as diagnosed by transient elastography values >8 kilopascal (kPa).…”

The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis

“…On top of this, a retrospectively collected data on 476 patients suggested a low-dose prednisone (0.1–5.0 mg/day) increased the odds of fractures whereas higher doses (> 5.0 mg/day) increased the odds of cataracts and diabetes. Thus, even low doses of corticosteroids frequently lead to substantial adverse events arguing against the assumption that adverse events are prevented by administering low doses [ 230 ].…”

Mesenchymal stem cell-based treatment in autoimmune liver diseases: underlying roles, advantages and challenges

“… 98 Moreover, a study from the Netherlands showed that low doses of corticosteroids could still lead to substantial adverse events such as bone fractures, which contradicted the assumption that administering low doses of corticosteroids could prevent adverse events. 99 Thus, AIH patients need to seek alternatives to traditional treatment.…”