Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management

Vierling, John M.

doi:10.1016/j.cgh.2015.08.012

Cited by 54 publications

(28 citation statements)

References 214 publications

(226 reference statements)

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“…1–7 Clinical manifestations of AIH range from no symptoms to severe acute hepatitis, and rarely fulminant hepatic failure. 5,8 Approximately one third of patients with AIH have evidence of cirrhosis at the time of initial diagnosis. 3,4 Additionally, patients with AIH progress to cirrhosis at variable rates (ranging from 0.1 to 8.1% annually) despite treatment with immunosuppressive therapies.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: A Systematic Review and Meta-analysis

Tansel

Katz

El–Serag

et al. 2017

Clinical Gastroenterology and Hepatology

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Background The risk of hepatocellular carcinoma (HCC) in patients with autoimmune hepatitis (AIH) is unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and associated risk factors among patients with AIH. Methods We searched PubMed, Embase, and reference lists from relevant articles through June 2016 to identify cohort studies that examined the incidence of HCC in patients with AIH. We used random effects models to estimate pooled incidence rates overall and in subgroup of patients with cirrhosis. The between-study heterogeneity was assessed using I2 statistic. Results A total of 25 studies (20 papers and 5 abstracts) including 6,528 patients met the eligibility criteria. The median cohort size was 170 AIH patients (range 25–1721 patients) followed for a median of 8.0 years (range 3.3–16.0 years). The pooled incidence rate for HCC in patients with AIH was 3.06 per 1,000 patient-years (95% CI 2.22–4.23, I2 51.5%, p 0.002). The pooled incidence of HCC in patients with cirrhosis at AIH diagnosis was 10.07 per 1,000 patient-years (95% CI 6.89–14.70, I2 48.8%, p 0.015). In addition, 92 of 93 patients that had HCC had evidence of cirrhosis prior to or at time of HCC diagnosis. The risk of HCC appears to be lower in patients with AIH cirrhosis compared to that reported in patients with hepatitis B cirrhosis, hepatitis C cirrhosis, and primary biliary cholangitis. Conclusions Based on elevated HCC risk shown in this meta-analysis, there may be a role for HCC surveillance in patients with AIH cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: A Systematic Review and Meta-analysis

Tansel

Katz

El–Serag

et al. 2017

Clinical Gastroenterology and Hepatology

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“…High‐quality data on the management of AIH are scarce, with therapeutic data largely informed by randomised trials published over four decades ago . In addition, decisions regarding the use of second‐line therapies are based on small series or even case reports, mostly reporting the experience of a limited number of centres with a special interest in AIH …”

Section: Introductionmentioning

confidence: 99%

Expert clinical management of autoimmune hepatitis in the real world

Liberal

Boer²,

Andrade³

et al. 2016

Aliment Pharmacol Ther

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“…A variety of clinical presentations can be observed ranging from mild, almost subclinical disease to fulminant hepatitis [1]. While the pathogenesis is not fully understood, the current hypothesis is that an environmental agent is thought to trigger a dysregulated T-cell response against auto antigens in genetically susceptible individuals.…”

Section: Introductionmentioning

confidence: 99%

The use of immunosuppression in autoimmune hepatitis: A current literature review

Cropley

Weltman

2017

Clin Mol Hepatol

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Autoimmune hepatitis (AIH) is an organ specific autoimmune condition which can manifest at any age of life. The heterogeneous nature of this condition means that great variation can be seen in severity, progression of disease and response to treatment within this patient group. Since the 1980s prednisolone and azathioprine have been used for induction and remission of the disease and remain the mainstay of treatment. Other immunosuppressive agents have been employed in difficult to treat cases. While there is less published data regarding these agents compared with the conventional treatments of steroid and azathioprine, there is mounting evidence to support the use of mycophenolate mofetil as a second-line agent. The calcineurin inhibitors, though less studied, additionally show promise. More data is needed on the use of biological agents in refractory disease. This review focuses on our centre’s approach to treatment of AIH in the context of a contemporary review of the literature.

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Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management

Cited by 54 publications

References 214 publications

Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: A Systematic Review and Meta-analysis

Incidence and Determinants of Hepatocellular Carcinoma in Autoimmune Hepatitis: A Systematic Review and Meta-analysis

Expert clinical management of autoimmune hepatitis in the real world

The use of immunosuppression in autoimmune hepatitis: A current literature review

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