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Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis

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Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis. / Pape, Simon; Gevers, Tom J G; Belias, Michail; Mustafajev, Ilyas F; Vrolijk, Jan Maarten; van Hoek, Bart; Bouma, Gerd; van Nieuwkerk, Carin M J; Hartl, Johannes; Schramm, Christoph; Lohse, Ansgar W; Taubert, Richard; Jaeckel, Elmar; Manns, Michael P; Papp, Maria; Stickel, Felix; Heneghan, Michael A; Drenth, Joost P H.

In: CLIN GASTROENTEROL H, Vol. 17, No. 10, 09.2019, p. 2068-2075.e2.

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

Harvard

Pape, S, Gevers, TJG, Belias, M, Mustafajev, IF, Vrolijk, JM, van Hoek, B, Bouma, G, van Nieuwkerk, CMJ, Hartl, J, Schramm, C, Lohse, AW, Taubert, R, Jaeckel, E, Manns, MP, Papp, M, Stickel, F, Heneghan, MA & Drenth, JPH 2019, 'Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis', CLIN GASTROENTEROL H, vol. 17, no. 10, pp. 2068-2075.e2. https://doi.org/10.1016/j.cgh.2018.12.035

APA

Pape, S., Gevers, T. J. G., Belias, M., Mustafajev, I. F., Vrolijk, J. M., van Hoek, B., Bouma, G., van Nieuwkerk, C. M. J., Hartl, J., Schramm, C., Lohse, A. W., Taubert, R., Jaeckel, E., Manns, M. P., Papp, M., Stickel, F., Heneghan, M. A., & Drenth, J. P. H. (2019). Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis. CLIN GASTROENTEROL H, 17(10), 2068-2075.e2. https://doi.org/10.1016/j.cgh.2018.12.035

Vancouver

Pape S, Gevers TJG, Belias M, Mustafajev IF, Vrolijk JM, van Hoek B et al. Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis. CLIN GASTROENTEROL H. 2019 Sep;17(10):2068-2075.e2. https://doi.org/10.1016/j.cgh.2018.12.035

Bibtex

@article{4f12317a270b46d2ba2997264352964a,
title = "Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis",
abstract = "BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) commonly receive induction therapy with predniso(lo)ne followed by maintenance therapy with azathioprine. European Association for Study of the Liver clinical practice guidelines advise a predniso(lo)ne dose range of 0.50-1 mg/kg/day, which leaves room for practice variation. We performed a multicenter study to determine the efficacy of different dose ranges of predniso(lo)ne induction therapy in a large European cohort of patients with AIH.METHODS: We performed a retrospective cohort study using a comparative effectiveness design. We collected data from 451 adults with AIH who began treatment from 1978 through 2017 at 9 centers in 5 European countries. We assigned patients to a high-dose group (initial predniso(lo)ne dose ≥0.50 mg/kg/day; n=281) or a low-dose group (<0.50 mg/kg/day; n=170). Logistic regression was performed to determine difference in outcomes between the groups. The primary outcome was normal serum levels of transaminases at 6 months after initiation of therapy.RESULTS: There was no significant difference in rates of normalization of transaminases between the high-dose predniso(lo)ne group and the low-dose group (70.5% vs 64.7%; P=.20). After multivariable logistic regression with correction for confounders, there was no difference in the likelihood of normalization of transaminases between the groups (odds ratio, 1.21; 95% CI, 0.78 - 1.87; P=.38). Patients given an initial high dose of predniso(lo)ne received more predniso(lo)ne over time than patients started on a lower dose (median doses over 6 months: 3780 mg vs 2573 mg) (P<.01).CONCLUSIONS: In a retrospective study of patients with AIH in Europe, we found that the dose of predniso(lo)ne to induce remission in patients with AIH is less relevant than assumed. An initial predniso(lo)ne dose below 0.50 mg/kg/day substantially decreases unnecessary exposure to predniso(lo)ne in patients with AIH.",
keywords = "Journal Article",
author = "Simon Pape and Gevers, {Tom J G} and Michail Belias and Mustafajev, {Ilyas F} and Vrolijk, {Jan Maarten} and {van Hoek}, Bart and Gerd Bouma and {van Nieuwkerk}, {Carin M J} and Johannes Hartl and Christoph Schramm and Lohse, {Ansgar W} and Richard Taubert and Elmar Jaeckel and Manns, {Michael P} and Maria Papp and Felix Stickel and Heneghan, {Michael A} and Drenth, {Joost P H}",
note = "Copyright {\textcopyright} 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = sep,
doi = "10.1016/j.cgh.2018.12.035",
language = "English",
volume = "17",
pages = "2068--2075.e2",
journal = "CLIN GASTROENTEROL H",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "10",

}

RIS

TY - JOUR

T1 - Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis

AU - Pape, Simon

AU - Gevers, Tom J G

AU - Belias, Michail

AU - Mustafajev, Ilyas F

AU - Vrolijk, Jan Maarten

AU - van Hoek, Bart

AU - Bouma, Gerd

AU - van Nieuwkerk, Carin M J

AU - Hartl, Johannes

AU - Schramm, Christoph

AU - Lohse, Ansgar W

AU - Taubert, Richard

AU - Jaeckel, Elmar

AU - Manns, Michael P

AU - Papp, Maria

AU - Stickel, Felix

AU - Heneghan, Michael A

AU - Drenth, Joost P H

N1 - Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2019/9

Y1 - 2019/9

N2 - BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) commonly receive induction therapy with predniso(lo)ne followed by maintenance therapy with azathioprine. European Association for Study of the Liver clinical practice guidelines advise a predniso(lo)ne dose range of 0.50-1 mg/kg/day, which leaves room for practice variation. We performed a multicenter study to determine the efficacy of different dose ranges of predniso(lo)ne induction therapy in a large European cohort of patients with AIH.METHODS: We performed a retrospective cohort study using a comparative effectiveness design. We collected data from 451 adults with AIH who began treatment from 1978 through 2017 at 9 centers in 5 European countries. We assigned patients to a high-dose group (initial predniso(lo)ne dose ≥0.50 mg/kg/day; n=281) or a low-dose group (<0.50 mg/kg/day; n=170). Logistic regression was performed to determine difference in outcomes between the groups. The primary outcome was normal serum levels of transaminases at 6 months after initiation of therapy.RESULTS: There was no significant difference in rates of normalization of transaminases between the high-dose predniso(lo)ne group and the low-dose group (70.5% vs 64.7%; P=.20). After multivariable logistic regression with correction for confounders, there was no difference in the likelihood of normalization of transaminases between the groups (odds ratio, 1.21; 95% CI, 0.78 - 1.87; P=.38). Patients given an initial high dose of predniso(lo)ne received more predniso(lo)ne over time than patients started on a lower dose (median doses over 6 months: 3780 mg vs 2573 mg) (P<.01).CONCLUSIONS: In a retrospective study of patients with AIH in Europe, we found that the dose of predniso(lo)ne to induce remission in patients with AIH is less relevant than assumed. An initial predniso(lo)ne dose below 0.50 mg/kg/day substantially decreases unnecessary exposure to predniso(lo)ne in patients with AIH.

AB - BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) commonly receive induction therapy with predniso(lo)ne followed by maintenance therapy with azathioprine. European Association for Study of the Liver clinical practice guidelines advise a predniso(lo)ne dose range of 0.50-1 mg/kg/day, which leaves room for practice variation. We performed a multicenter study to determine the efficacy of different dose ranges of predniso(lo)ne induction therapy in a large European cohort of patients with AIH.METHODS: We performed a retrospective cohort study using a comparative effectiveness design. We collected data from 451 adults with AIH who began treatment from 1978 through 2017 at 9 centers in 5 European countries. We assigned patients to a high-dose group (initial predniso(lo)ne dose ≥0.50 mg/kg/day; n=281) or a low-dose group (<0.50 mg/kg/day; n=170). Logistic regression was performed to determine difference in outcomes between the groups. The primary outcome was normal serum levels of transaminases at 6 months after initiation of therapy.RESULTS: There was no significant difference in rates of normalization of transaminases between the high-dose predniso(lo)ne group and the low-dose group (70.5% vs 64.7%; P=.20). After multivariable logistic regression with correction for confounders, there was no difference in the likelihood of normalization of transaminases between the groups (odds ratio, 1.21; 95% CI, 0.78 - 1.87; P=.38). Patients given an initial high dose of predniso(lo)ne received more predniso(lo)ne over time than patients started on a lower dose (median doses over 6 months: 3780 mg vs 2573 mg) (P<.01).CONCLUSIONS: In a retrospective study of patients with AIH in Europe, we found that the dose of predniso(lo)ne to induce remission in patients with AIH is less relevant than assumed. An initial predniso(lo)ne dose below 0.50 mg/kg/day substantially decreases unnecessary exposure to predniso(lo)ne in patients with AIH.

KW - Journal Article

U2 - 10.1016/j.cgh.2018.12.035

DO - 10.1016/j.cgh.2018.12.035

M3 - SCORING: Journal article

C2 - 30625402

VL - 17

SP - 2068-2075.e2

JO - CLIN GASTROENTEROL H

JF - CLIN GASTROENTEROL H

SN - 1542-3565

IS - 10

ER -