19 research outputs found
Expert clinical management of autoimmune hepatitis in the real world
Item does not contain fulltextBACKGROUND: High-quality data on the management of autoimmune hepatitis (AIH) are scarce. Despite published guidelines, management of AIH is still expert based rather than evidence based. AIM: To survey expert hepatologists, asking each to describe their practices in the management of patients with AIH. METHODS: A survey questionnaire was distributed to members of the International AIH Group. The questionnaire consisted of four clinical scenarios on different presentations of AIH. RESULTS: Sixty surveys were sent, out of which 37 were returned. None reported budesonide as a first line induction agent for the acute presentation of AIH. Five (14%) participants reported using thiopurine S-methyltransferase measurements before commencement of thiopurine maintenance therapy. Thirteen (35%) routinely perform liver biopsy at 2 years of biochemical remission. If histological inflammatory activity is absent, four (11%) participants reduced azathioprine, whereas 10 (27%) attempted withdrawal altogether. Regarding the management of difficult-to-treat patients, mycophenolate mofetil is the most widely used second-line agent (n = ~450 in 28 centres), whereas tacrolimus (n = ~115 in 21 centres) and ciclosporin (n = ~112 in 18 centres) are less often reported. One centre reported considerable experience with infliximab, while rescue therapy with rituximab has been tried in seven centres. CONCLUSIONS: There is a wide variation in the management of patients with autoimmune hepatitis even among the most expert in the field. Although good quality evidence is lacking, there is considerable experience with second-line therapies. Future prospective studies should address these issues, so that we move from an expert- to an evidence- and personalised-based care in autoimmune hepatitis
Expert clinical management of autoimmune hepatitis in the real world
none17sinoneLiberal, R.; de Boer, Y.S.; Andrade, R.J.; Bouma, G.; Dalekos, G.N.; Floreani, A.; Gleeson, D.; Hirschfield, G.M.; Invernizzi, P.; Lenzi, M.; Lohse, A.W.; Macedo, G.; Milkiewicz, P.; Terziroli, B.; van Hoek, B.; Vierling, J.M.; Heneghan, M.ALiberal, R.; de Boer, Y. S.; Andrade, R. J.; Bouma, G.; Dalekos, G. N.; Floreani, Annarosa; Gleeson, D.; Hirschfield, G. M.; Invernizzi, P.; Lenzi, M.; Lohse, A. W.; Macedo, G.; Milkiewicz, P.; Terziroli, B.; van Hoek, B.; Vierling, J. M.; Heneghan, M. A
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Association Between Black Race and Presentation and Liver-Related Outcomes of Patients With Autoimmune Hepatitis
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