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Expert clinical management of autoimmune hepatitis in the real world

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Expert clinical management of autoimmune hepatitis in the real world. / Liberal, 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 A; International Autoimmune Hepatitis Group (IAIHG).

In: ALIMENT PHARM THER, Vol. 45, No. 5, 03.2017, p. 723-732.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Liberal, R, de Boer, YS, Andrade, RJ, Bouma, G, Dalekos, GN, Floreani, A, Gleeson, D, Hirschfield, GM, Invernizzi, P, Lenzi, M, Lohse, AW, Macedo, G, Milkiewicz, P, Terziroli, B, van Hoek, B, Vierling, JM, Heneghan, MA & International Autoimmune Hepatitis Group (IAIHG) 2017, 'Expert clinical management of autoimmune hepatitis in the real world', ALIMENT PHARM THER, vol. 45, no. 5, pp. 723-732. https://doi.org/10.1111/apt.13907

APA

Liberal, 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. A., & International Autoimmune Hepatitis Group (IAIHG) (2017). Expert clinical management of autoimmune hepatitis in the real world. ALIMENT PHARM THER, 45(5), 723-732. https://doi.org/10.1111/apt.13907

Vancouver

Liberal R, de Boer YS, Andrade RJ, Bouma G, Dalekos GN, Floreani A et al. Expert clinical management of autoimmune hepatitis in the real world. ALIMENT PHARM THER. 2017 Mar;45(5):723-732. https://doi.org/10.1111/apt.13907

Bibtex

@article{583af7a94c7a4e51b030160cbc375ef2,
title = "Expert clinical management of autoimmune hepatitis in the real world",
abstract = "BACKGROUND: 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.",
author = "R Liberal and {de Boer}, {Y S} and Andrade, {R J} and G Bouma and Dalekos, {G N} and A Floreani and D Gleeson and Hirschfield, {G M} and P Invernizzi and M Lenzi and Lohse, {A W} and G Macedo and P Milkiewicz and B Terziroli and {van Hoek}, B and Vierling, {J M} and Heneghan, {M A} and {International Autoimmune Hepatitis Group (IAIHG)}",
note = "{\textcopyright} 2016 John Wiley & Sons Ltd.",
year = "2017",
month = mar,
doi = "10.1111/apt.13907",
language = "English",
volume = "45",
pages = "723--732",
journal = "ALIMENT PHARM THER",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "5",

}

RIS

TY - JOUR

T1 - Expert clinical management of autoimmune hepatitis in the real world

AU - Liberal, R

AU - de Boer, Y S

AU - Andrade, R J

AU - Bouma, G

AU - Dalekos, G N

AU - Floreani, A

AU - Gleeson, D

AU - Hirschfield, G M

AU - Invernizzi, P

AU - Lenzi, M

AU - Lohse, A W

AU - Macedo, G

AU - Milkiewicz, P

AU - Terziroli, B

AU - van Hoek, B

AU - Vierling, J M

AU - Heneghan, M A

AU - International Autoimmune Hepatitis Group (IAIHG)

N1 - © 2016 John Wiley & Sons Ltd.

PY - 2017/3

Y1 - 2017/3

N2 - BACKGROUND: 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.

AB - BACKGROUND: 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.

U2 - 10.1111/apt.13907

DO - 10.1111/apt.13907

M3 - SCORING: Journal article

C2 - 28004405

VL - 45

SP - 723

EP - 732

JO - ALIMENT PHARM THER

JF - ALIMENT PHARM THER

SN - 0269-2813

IS - 5

ER -