Letter: reversibility of hepatic fibrosis and immunosuppression withdrawal in patients with autoimmune hepatitis/primary biliary cirrhosis overlap syndrome
Bibliographic record
Abstract
In his recent articles,1, 2 Dr Czaja has evaluated the prevention of hepatic fibrosis and permanent immunosuppression withdrawal, which are very important issues in the management of autoimmune hepatitis (AIH). Patients with AIH may also present with features of primary biliary cirrhosis (PBC) or vice versa. The term of overlap or variant syndromes have been used to describe this clinical condition.3, 4 AIH/PBC is rare, but a real clinical entity that should be better diagnosed and treated. We would like to discuss these issues in patients with AIH/PBC overlap. In a recent large population-based study,5 the authors evaluated data from 88 AIH/PBC patients. Among them, control liver biopsy was performed in 23 biochemical responders. The fibrosis scores decreased or remained unchanged in 90% (21/23) of patients. Furthermore, immunosuppression was successfully withdrawn in 75% (15/20) of patients with AIH/PBC. In another study,6 fibrosis progression was prevented in 100% (6/6) of patients treated by immunosuppression, and relapses were not observed in 100% (4/4) of patients after immunosuppression withdrawal. Despite small cohort sizes, these results suggest that prevention of fibrosis progression and immunosuppression-free management is a realistic expectation for patients with AIH/PBC overlap. These studies also raise an old question as to whether AIH/PBC is a coexistence of two different autoimmune liver diseases, or a variant of AIH or PBC, with some overlapping features. Relapse-free rates after immunosuppression withdrawal are higher in AIH/PBC overlap than patients with pure AIH. Furthermore, prevention of fibrosis progression seems to be more common in overlap patients than those with pure AIH or PBC. Declaration of personal and funding interests: None.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.010 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".