Highlights
- •Complete biochemical remission is a reliable surrogate of low histological disease activity.
- •Transient elastography is a non-invasive tool to monitor fibrosis development in autoimmune hepatitis.
- •These study results may improve treatment monitoring in patients with autoimmune hepatitis.
- •Patients with autoimmune hepatitis have a high chance of fibrosis regression if inflammation is suppressed.
Background & Aims
Liver fibrosis regression but also progression may occur in patients with autoimmune
hepatitis (AIH) under treatment. There is a need for non-invasive surrogate markers
for fibrosis development in AIH to better guide immunosuppressive treatment. The aims
of the study were to assess the impact of complete biochemical remission defined as
normalisation of aminotransferases and IgG on histological activity and fibrosis development,
and the value of repeat transient elastography (TE) measurement for monitoring disease
progression in AIH.
Methods
A total of 131 liver biopsies from 60 patients with AIH and more than 900 TE from
125 patients with AIH, 130 with primary biliary cholangitis (PBC) and 100 with primary
sclerosing cholangitis (PSC), were evaluated. Time intervals between TE were at least
12 months. Patients with AIH were treated for at least six months at first TE.
Results
In contrast to PBC and PSC, a decrease of liver stiffness (LS) was observed in the
whole group of patients with AIH (−6.2%/year; 95% CI −12.6% to −0.2%; p = 0.04). The largest decrease of LS was observed in patients with severe fibrosis
at baseline (F4: −11.7%/year; 95% CI −19% to −3.5%; p = 0.006). Complete biochemical remission was strongly linked to regression of LS
(“remission”: −7.5%/year vs. “no remission”: +1.7%/year, p <0.001). Similarly, complete biochemical remission predicted low histological disease
activity and was the only independent predictor for histological fibrosis regression
(relative risk 3.66; 95% CI 1.54–10.2; p = 0.001). Patients with F3/F4-fibrosis, who remained in biochemical remission showed
a considerable decrease of fibrosis stage (3.7 ± 0.5 to 1.8 ± 1.7; p = 0.007) on histological follow-up.
Conclusions
This study demonstrates that complete biochemical remission is a reliable predictor
of a good prognosis in AIH and leads to fibrosis regression that can be monitored
by TE.
Lay summary
Autoimmune hepatitis is an inflammatory disease of the liver, which often progresses
to cirrhosis if left untreated or in the case of insufficient treatment response.
Current guidelines have defined biochemical remission (normalisation of biochemical
markers for liver inflammation) as a major goal in the treatment of AIH. However,
data on the prognostic relevance of this definition are scarce. Herein, we demonstrate
that the current definition of biochemical remission is a reliable surrogate for low
disease activity on histological assessment and for a beneficial long-term disease
course. In addition, we establish transient elastography, a non-invasive ultrasound-based
method of measuring scarring of liver tissue, as a reliable tool to monitor disease
course in AIH.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 24, 2017
Accepted:
November 10,
2017
Received in revised form:
November 7,
2017
Received:
June 16,
2017
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
