Treatment options for autoimmune hepatitis: A systematic review of randomized controlled trials
Notice bibliographique
Résumé
Background & AimsPredniso(lo)ne with or without azathioprine is considered the mainstay in the treatment of autoimmune hepatitis (AIH), but many therapeutic options are available. The primary objective of this review was to explore the published literature on the optimal induction and subsequent maintenance therapy for AIH.MethodsWe performed a systematic search on electronic databases MEDLINE (1950-07.2009), Web of Science, Cochrane, and the website www.clinicaltrials.gov. Randomized controlled trials (RCTs) on apparent beneficial treatment regimens as induction or maintenance treatment in AIH were included. Pediatric studies were excluded. We calculated relative risks (RR) for comparison of treatment options on the primary outcome measure, which was defined as clinical, biochemical and histological remission.ResultsEleven RCTs were included, of which 7 studies evaluated the induction therapy in AIH patients: 3 treatment naive (n = 253), 2 relapse (n = 53), 2 combination of naive and relapse (n = 110). The remaining 4 studies (n = 162) assessed maintenance therapy. All but one maintenance study (thymostimulin versus no therapy) studied predniso(lo)ne (PRED), azathioprine (AZA) or combination PRED + AZA. We found no differences in primary outcome between induction therapy with PRED and PRED + AZA in treatment naive patients (RR = 0.98; 95% CI 0.65–1.47). AZA monotherapy as induction was considered as not viable because of a high mortality rate (30%). This was similar in AIH patients who relapsed: RR for PRED versus PRED + AZA for inducing remission was not different: 0.71 (95% CI 0.37–1.39). PRED + AZA maintained remission more often than PRED (RR = 1.40; 95% CI 1.13–1.73). Also AZA maintained a higher remission rate than PRED (RR = 1.35; 95% CI 1.07–1.70). Maintenance of remission was not different between PRED + AZA and AZA (RR = 1.06; 95% CI 0.94–1.20).ConclusionsBased on available RCTs, PRED monotherapy and PRED + AZA combination therapy are both viable induction therapies for AIH treatment naives and relapsers, while for maintenance therapy PRED + AZA and AZA therapy are superior to PRED monotherapy. Predniso(lo)ne with or without azathioprine is considered the mainstay in the treatment of autoimmune hepatitis (AIH), but many therapeutic options are available. The primary objective of this review was to explore the published literature on the optimal induction and subsequent maintenance therapy for AIH. We performed a systematic search on electronic databases MEDLINE (1950-07.2009), Web of Science, Cochrane, and the website www.clinicaltrials.gov. Randomized controlled trials (RCTs) on apparent beneficial treatment regimens as induction or maintenance treatment in AIH were included. Pediatric studies were excluded. We calculated relative risks (RR) for comparison of treatment options on the primary outcome measure, which was defined as clinical, biochemical and histological remission. Eleven RCTs were included, of which 7 studies evaluated the induction therapy in AIH patients: 3 treatment naive (n = 253), 2 relapse (n = 53), 2 combination of naive and relapse (n = 110). The remaining 4 studies (n = 162) assessed maintenance therapy. All but one maintenance study (thymostimulin versus no therapy) studied predniso(lo)ne (PRED), azathioprine (AZA) or combination PRED + AZA. We found no differences in primary outcome between induction therapy with PRED and PRED + AZA in treatment naive patients (RR = 0.98; 95% CI 0.65–1.47). AZA monotherapy as induction was considered as not viable because of a high mortality rate (30%). This was similar in AIH patients who relapsed: RR for PRED versus PRED + AZA for inducing remission was not different: 0.71 (95% CI 0.37–1.39). PRED + AZA maintained remission more often than PRED (RR = 1.40; 95% CI 1.13–1.73). Also AZA maintained a higher remission rate than PRED (RR = 1.35; 95% CI 1.07–1.70). Maintenance of remission was not different between PRED + AZA and AZA (RR = 1.06; 95% CI 0.94–1.20). Based on available RCTs, PRED monotherapy and PRED + AZA combination therapy are both viable induction therapies for AIH treatment naives and relapsers, while for maintenance therapy PRED + AZA and AZA therapy are superior to PRED monotherapy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,044 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,015 | 0,013 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».