High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation
Standard
High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation. / Pape, Simon; Gevers, Tom J G; Vrolijk, Jan Maarten; van Hoek, Bart; Bouma, Gerd; van Nieuwkerk, Carin M J; Taubert, Richard; Jaeckel, Elmar; Manns, Michael P; Papp, Maria; Sipeki, Nora; Stickel, Felix; Efe, Cumali; Ozaslan, Ersan; Purnak, Tugrul; Nevens, Frederik; Kessener, Dominik J N; Kahraman, Alisan; Wedemeyer, Heiner; Hartl, Johannes; Schramm, Christoph; Lohse, Ansgar W; Heneghan, Michael A; Drenth, Joost P H.
In: LIVER INT, Vol. 40, No. 9, 09.2020, p. 2164-2171.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation
AU - Pape, Simon
AU - Gevers, Tom J G
AU - Vrolijk, Jan Maarten
AU - van Hoek, Bart
AU - Bouma, Gerd
AU - van Nieuwkerk, Carin M J
AU - Taubert, Richard
AU - Jaeckel, Elmar
AU - Manns, Michael P
AU - Papp, Maria
AU - Sipeki, Nora
AU - Stickel, Felix
AU - Efe, Cumali
AU - Ozaslan, Ersan
AU - Purnak, Tugrul
AU - Nevens, Frederik
AU - Kessener, Dominik J N
AU - Kahraman, Alisan
AU - Wedemeyer, Heiner
AU - Hartl, Johannes
AU - Schramm, Christoph
AU - Lohse, Ansgar W
AU - Heneghan, Michael A
AU - Drenth, Joost P H
N1 - © 2020 The Authors. Liver International published by John Wiley & Sons Ltd.
PY - 2020/9
Y1 - 2020/9
N2 - BACKGROUND: Guidelines regarding treatment for autoimmune hepatitis (AIH) favour two strategies for azathioprine (AZA) introduction: concurrent with steroids at induction or delayed by 2-4 weeks. The safety and efficacy of both strategies have been unexplored.METHODS: We established a cohort of 900 AIH patients from 12 centres in 7 European countries. There were 631 patients who used AZA as part of the therapeutic regimen. We distinguished two groups: patients with early AZA (<2 weeks) or delayed AZA initiation (≥2 weeks). Primary outcome was discontinuation of AZA in the first year of treatment. Cox regression and propensity score matching was performed to determine difference in outcomes between groups.RESULTS: Patients with early AZA initiation had significantly lower transaminases and bilirubin at baseline. Discontinuation rates of AZA did not differ between early and delayed starters (16.6% vs 14.2%), which did not reach statistical significance (hazard ratio 0.97, 95% confidence interval 0.61-1.55, P = .90). Stratification according to baseline disease activity or propensity score matching did not alter the results. Main reason for AZA discontinuation was intolerance to treatment (14.0% vs 13.2%, P = .78) with nausea and vomiting as main side effects. AIH remission rates were comparable among groups.CONCLUSION: The discontinuation rate of AZA in AIH treatment is ~15% in the first year of treatment. Early or delayed AZA initiation does not differ in remission and discontinuation rates in AIH induction therapy. Our data suggest that either strategy may be used as part of AIH treatment.
AB - BACKGROUND: Guidelines regarding treatment for autoimmune hepatitis (AIH) favour two strategies for azathioprine (AZA) introduction: concurrent with steroids at induction or delayed by 2-4 weeks. The safety and efficacy of both strategies have been unexplored.METHODS: We established a cohort of 900 AIH patients from 12 centres in 7 European countries. There were 631 patients who used AZA as part of the therapeutic regimen. We distinguished two groups: patients with early AZA (<2 weeks) or delayed AZA initiation (≥2 weeks). Primary outcome was discontinuation of AZA in the first year of treatment. Cox regression and propensity score matching was performed to determine difference in outcomes between groups.RESULTS: Patients with early AZA initiation had significantly lower transaminases and bilirubin at baseline. Discontinuation rates of AZA did not differ between early and delayed starters (16.6% vs 14.2%), which did not reach statistical significance (hazard ratio 0.97, 95% confidence interval 0.61-1.55, P = .90). Stratification according to baseline disease activity or propensity score matching did not alter the results. Main reason for AZA discontinuation was intolerance to treatment (14.0% vs 13.2%, P = .78) with nausea and vomiting as main side effects. AIH remission rates were comparable among groups.CONCLUSION: The discontinuation rate of AZA in AIH treatment is ~15% in the first year of treatment. Early or delayed AZA initiation does not differ in remission and discontinuation rates in AIH induction therapy. Our data suggest that either strategy may be used as part of AIH treatment.
U2 - 10.1111/liv.14513
DO - 10.1111/liv.14513
M3 - SCORING: Journal article
C2 - 32410363
VL - 40
SP - 2164
EP - 2171
JO - LIVER INT
JF - LIVER INT
SN - 1478-3223
IS - 9
ER -