Expert clinical management of autoimmune hepatitis in the real world

Liberal, Rodrigo; Boer, Ynto S. de; Andrade, Raúl J.; Bouma, Gerd; Dalekos, George Ν.; Floreani, Annarosa; Gleeson, Dermot; Hirschfield, Gideon M.; Invernizzi, Pietro; Lenzi, Marco; Lohse, Ansgar W.; Macedo, Guilherme; Milkiewicz, Piotr; Terziroli, Benedetta; Hoek, Bart van; Vierling, John M.; Heneghan, Michael A.

doi:10.1111/apt.13907

Cited by 80 publications

(82 citation statements)

References 46 publications

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“…In AIH, the majority of data relating to treatment outcomes is derived from large referral centres . Even amongst these expert centres, significant differences exist in relation to approach to treatment …”

Section: Introductionmentioning

confidence: 99%

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

Dyson

Wong

Bigirumurame

et al. 2018

Aliment Pharmacol Ther

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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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Section: Introductionmentioning

confidence: 99%

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

Dyson

Wong

Bigirumurame

et al. 2018

Aliment Pharmacol Ther

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“…If untreated, it progresses to liver cirrhosis and its complications including liver failure and hepatocellular cancer (HCC) . Current therapy is based on immunosuppression which induces remission in majority of patients however relapses are frequent . Health‐related quality of life (HRQoL) in the setting of AIH is an issue that has not gained much clinical or scientific attention so far.…”

Section: Introductionmentioning

confidence: 99%

Autoimmune hepatitis exerts a profound, negative effect on health‐related quality of life: A prospective, single‐centre study

Janik

Wunsch

Raszeja‐Wyszomirska

et al. 2018

Liver International

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“…For this reason, although the survey was broad in its remit, we ensured an appropriate level of expertise in the respondents. This approach has been used for AIH in a similar manner . A total of 80 responses were obtained from 23 countries and five continents; thus, this analysis reflects a global view.…”

Section: Discussionmentioning

confidence: 99%

Primary Sclerosing Cholangitis With Features of Autoimmune Hepatitis: Exploring the Global Variation in Management

et al. 2020

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Patients with primary sclerosing cholangitis (PSC) frequently manifest features of autoimmune hepatitis (AIH). We sought to understand factors affecting expert management, with the goal of facilitating uniformity of care. A Survey Monkey questionnaire with four hypothetical cases suggesting a potential AIH/PSC variant was sent to hepatologists spanning global practices. Eighty responses from clinicians in 23 countries were obtained. Most of the respondents would request a liver biopsy, and stated that the cases presented could not be appropriately managed without a biopsy. Despite the fact that histology did not unequivocally support an AIH/PSC variant in three of the four cases, this diagnosis was reached by most of the respondents for all cases, except case 1, in which 49% were diagnosed with AIH/PSC. There was a wide variation of suggested medical treatment. For three cases, the most commonly chosen treatment options did not exceed 35%, indicating a lack management consensus. Most respondents would treat with ursodeoxycholic acid, despite current American Association for the Study of Liver Diseases guidelines, either alone or in combination with immunosuppression. European clinicians recommended ursodeoxycholic acid more frequently than their counterparts in North America (P < 0.05 in three out of four cases), who advocated the use of immunosuppression alone more commonly than Europeans (P = 0.005 in case 2). Conclusions: We document a wide variation in clinical decision making in the context of managing patients with a potential AIH/PSC variant. Guidance, likely based on systematic studies arising from prospective registries, is needed to better address this difficult clinician problem.

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Expert clinical management of autoimmune hepatitis in the real world

Cited by 80 publications

References 46 publications

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

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

Autoimmune hepatitis exerts a profound, negative effect on health‐related quality of life: A prospective, single‐centre study

Primary Sclerosing Cholangitis With Features of Autoimmune Hepatitis: Exploring the Global Variation in Management

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