O9 Efficacy and safety of third-line therapies in autoimmune hepatitis: short- and long-term outcomes from a real-world cohort
Notice bibliographique
Résumé
Background and Aims Evidence regarding the short- and long-term efficacy and safety of third-line therapies in autoimmune hepatitis (AIH) remains limited. We aimed to evaluate both the efficacy and safety outcomes of third-line agents. Method We conducted a retrospective review of 704 AIH patients treated at our tertiary liver center between 1975 and May 2024. Patients who received third-line therapy for at least six months were included in the analysis. Results Of the 93 included patients, 74 (79.6%) were female, with a median age of 47 years (IQR 30–63.7). Twenty-eight percent of patients were not exposed to thiopurines. Mycophenolate mofetil (MMF) was initiated in 68 patients (73.1%). MMF treatment was discontinued in nine patients due to side effects, seven for family planning, and three due to lack of efficacy. Median follow-up time on MMF was 168 months (23.1–168). Biochemical response was 53.0% at 6 months and 64.0% at 12 months. Transaminase normalisation was achieved in 59.1% at 6 months and 68.9% at 12 months. Tacrolimus (TAC) was used in 51 patients (54.8%); four discontinued treatments (in one patient due clinical trial enrolment, one due to HPV-related cervical intraepithelial neoplasia, one for inefficacy, and one due to cytopenia), with a median follow-up time of 59.4 months (14.2–62.8). Biochemical response was 37.0% at 6 months and 34.2% at 12 months. Transaminase normalisation was achieved in 40.5% at 6 months and 42.1% at 12 months. No increased risk of renal dysfunction or metabolic complications — including diabetes, prediabetes, and hyperlipidaemia — was observed in patients receiving TAC. Triple therapy was used in 18 patients (19.4%), most commonly a combination of TAC, steroids, and MMF, with a median treatment duration of 62.4 months (26.4–139.6). Biochemical response was 37.5% at 6 months and 31.2% at 12 months. Transaminase normalisation was achieved in 37.5% at both 6 and months. Median clinical event-free survival was 148.3 months (48–189.3) in patients treated with MMF (n = 42, including 14 not exposed to AZA), 53.5 months (18.5–85.2) in patients treated with TAC (n = 33, including 5 not exposed to AZA) and 59.7 months (22.2–119.1) in patients treated with triple therapy (n = 18). Two cases of viremia, two abscesses, two chest infections, and one fungal nail infection were noted during follow-up. Conclusion In this single-centre cohort of difficult-to-treat AIH patients, third-line therapies showed favourable short- and long-term outcomes, including improved biochemistry, prolonged event-free survival, and good safety profile.
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 | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».