Optimizing the tapering scheme of corticosteroid treatment for acute onset of autoimmune hepatitis

IF 7.9 1区医学 Q1 IMMUNOLOGY

Journal of autoimmunity Pub Date : 2025-02-26 DOI:10.1016/j.jaut.2025.103387

Rui Wang , Qiuxiang Lin , Li Sheng , Yan Zhang , Haoyu Wen , You Li , Mingxia Shi , Xiao Xiao , Li Yan , Canjie Guo , Qi Miao , Jing Hua , Zuxiong Huang , Hai Li , M. Eric Gershwin , Qixia Wang , Xiong Ma , Min Lian

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Abstract

Background

Uncertainties persist regarding the optimal management of acute onset of autoimmune hepatitis, including the use of corticosteroids. This study aimed to compare the effectiveness and safety of rapid versus slow corticosteroid tapering in acute onset of AIH.

Methods

A multicenter study involving patients with acute AIH was conducted. We defined acute AIH as an acute presentation (<30 days) with AIH and exhibiting no evidence of pre-existing liver diseases. Initially, corticosteroid treatment and overall outcomes were reported. Subsequently, the role of corticosteroid tapering rate in modifying outcomes across subgroups was investigated. For patients with an initial corticosteroid dose of 20 mg/day or higher, we further classified patients into rapid tapering group (duration until dose of prednisone <20 mg/day <3 weeks) and slow tapering group (duration until dose of prednisone <20 mg/day ≥3 weeks). Adverse events were defined as any of the following events, progression (e.g., acute icteric AIH progression to AS-AIH or AIH-ALF, AS-AIH progression to AIH-ALF, non-cirrhotic progression to cirrhosis, compensated cirrhosis progression to decompensation), LT, and liver-related death.

Results

This retrospective cohort study enrolled 237 patients, with 109 presenting acute icteric AIH, 97 with acute-severe AIH (AS-AIH), and 31 with AIH-acute liver failure (ALF). Among patients with acute icteric AIH, slow tapering significantly improved adverse outcome-free survival compared to rapid tapering (99 % vs. 71 %, P < 0.0001). Similarly, in AS-AIH patients, slow tapering resulted in notably higher adverse outcome-free survival rates compared to rapid tapering (92 % vs. 54 %, P < 0.001). Slow tapering independently predicted fewer adverse events (OR 0.144; 95 % CI 0.037–0.562; P = 0.005). However, in AIH-acute liver failure (ALF) patients, tapering rate did not significantly affect adverse outcome-free survival (38 % vs. 50 %, P = 0.590). Overall, there were no significant differences in osteoporosis or infection occurrence between tapering groups in the entire acute AIH cohort.

Conclusion

A slow corticosteroid tapering reduced adverse outcomes in acute exacerbation of AIH patients, particularly in acute icteric AIH and AS-AIH.

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优化自身免疫性肝炎急性发作的皮质类固醇治疗的逐渐减少方案

背景：关于自身免疫性肝炎急性发作的最佳管理，包括皮质类固醇的使用，仍然存在不确定性。本研究旨在比较快速和缓慢皮质类固醇减量治疗急性AIH的有效性和安全性。方法对急性AIH患者进行多中心研究。我们将急性AIH定义为AIH的急性表现（30天），并且没有表现出先前存在肝脏疾病的证据。最初，报告了皮质类固醇治疗和总体结果。随后，研究了皮质类固醇减量率对亚组预后的影响。对于初始皮质类固醇剂量为20mg /天或更高的患者，我们进一步将患者分为快速减量组（持续时间至强的松剂量≤20mg /天≤3周）和缓慢减量组（持续时间至强的松剂量≤20mg /天≤3周）。不良事件被定义为以下任何事件：进展（例如，急性黄疸AIH进展为as -AIH或AIH- alf， as -AIH进展为AIH- alf，非肝硬化进展为肝硬化，代偿性肝硬化进展为失代偿），LT和肝脏相关死亡。这项回顾性队列研究纳入了237例患者，其中109例为急性黄疸AIH， 97例为急性重度AIH (AS-AIH)， 31例为AIH急性肝衰竭（ALF）。在急性黄疸AIH患者中，与快速减量相比，缓慢减量显著提高了无不良预后生存率(99% vs 71%, P <；0.0001)。类似地，在AS-AIH患者中，与快速减量相比，缓慢减量导致明显更高的无不良结局生存率(92% vs. 54%, P <；0.001)。缓慢减量独立预测更少的不良事件(OR 0.144；95% ci 0.037-0.562；p = 0.005)。然而，在aih急性肝衰竭（ALF）患者中，减量率对无不良预后生存率没有显著影响（38% vs. 50%, P = 0.590）。总体而言，在整个急性AIH队列中，减量组之间骨质疏松症或感染发生率无显著差异。结论慢性皮质类固醇减量可减少急性加重AIH患者的不良后果，特别是急性黄疸AIH和AS-AIH。

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来源期刊

Journal of autoimmunity 医学-免疫学

CiteScore

27.90

自引率

1.60%

发文量

117

审稿时长

17 days

期刊介绍： The Journal of Autoimmunity serves as the primary publication for research on various facets of autoimmunity. These include topics such as the mechanism of self-recognition, regulation of autoimmune responses, experimental autoimmune diseases, diagnostic tests for autoantibodies, as well as the epidemiology, pathophysiology, and treatment of autoimmune diseases. While the journal covers a wide range of subjects, it emphasizes papers exploring the genetic, molecular biology, and cellular aspects of the field. The Journal of Translational Autoimmunity, on the other hand, is a subsidiary journal of the Journal of Autoimmunity. It focuses specifically on translating scientific discoveries in autoimmunity into clinical applications and practical solutions. By highlighting research that bridges the gap between basic science and clinical practice, the Journal of Translational Autoimmunity aims to advance the understanding and treatment of autoimmune diseases.