Long-term management and prognosis of autoimmune hepatitis (AIH): A single center experience
Bibliographic record
Abstract
Background: Controlled trials have firmly established the need for immunosuppressive therapy in autoimmune hepatitis. However, reports about long-term management and prognosis of the disease are scarce. Patients and methods: We reviewed the charts of 103 consecutive patients with a well-documented long-term course of autoimmune hepatitis who had been carefully managed over a mean observation period of 95 months (12-405 months). Results: Under immunosuppressive therapy 94 patients (91.2 %) reached complete remission after a mean treatment duration of 3 ± 3 months. 28 of the 103 patients (27.2 %) were eligible for a trial of treatment withdrawal after a mean treatment duration of 32.2 months (range: 12-81 months). 21 of these patients (75 %) had a relapse following treatment withdrawal. 13.6 % of patients had intolerance of or severe side effects to azathioprine. There was no increase in tumor risk during a cumulative observation period of 423 patient-years of azathioprine therapy. Corticosteroid side effects occurred mostly during induction therapy, but were usually minor and resolved upon dose reduction. During a cumulative observation period of 842 patient-years no liver related deaths occurred and no patient had to be referred to liver transplantation, even though 30 patients (29.1 %) had histological evidence of cirrhosis at presentation. The overall 5- and 10-year survival of patients with autoimmune hepatitis was identical to an age- and sex-matched control population. Conclusion: Our study shows that the majority of patients with AIH do achieve a complete remission within 3 months, but require long-term or permanent immunosuppressive therapy that is usually well tolerated. Long-term survival in well-managed patients is excellent. Management und Prognose der autoimmunen Hepatitis: Erfahrungen eines Zentrums Einleitung: Kontrollierte Studien belegen den Wert einer immunsuppressiven Therapie zur Behandlung der autoimmunen Hepatitis. Allerdings liegen nur wenige Berichte über Langzeitverläufe und Prognose dieser Erkrankung vor. Patienten und Methodik: Die Krankenakten von 103 konsekutiven Patienten mit lückenlos dokumentiertem Verlauf einer autoimmunen Hepatitis, die wir über eine mittlere Beobachtungszeit von 95 Monaten (12-405 Monaten) betreuten, wurden ausgewertet. Ergebnisse: 94 Patienten (91,2 %) erreichten unter immunsuppressiver Therapie eine komplette Remission innerhalb von 3 ± 3 Monaten. Bei 28 Patienten (27,2 %) wurde nach einer mittleren Behandlungsdauer von 32,2 Monaten die immunsuppressive Therapie schrittweise beendet. 21 dieser Patienten (75 %) hatten ein Rezidiv der autoimmunen Hepatitis. 14 Patienten (13,6 %) konnten aufgrund von Unverträglichkeit oder Nebenwirkungen nicht mit Azathioprin behandelt werden. Während einer kumulativen Beobachtungsdauer von 423 Patientenjahren unter Azathioprintherapie beobachteten wir kein signifikant erhöhtes Tumorrisiko. Nebenwirkungen auf Kortikosteroide traten meist während der Induktionsphase auf, waren jedoch meist geringfügig und reversibel nach Dosisreduktion. Obwohl bereits 30 Patienten (29,1 %) bei Diagnosestellung eine Leberzirrhose aufwiesen, traten während einer kumulativen Beobachtungszeit von 842 Patientenjahren keine Todesfälle als Komplikation der Lebererkrankung auf. Kein Patient musste lebertransplantiert werden. Das 5- und 10-Jahres-Überleben unterschied sich nicht von dem eines Kontrollkollektivs. Schlussfolgerungen: Die Mehrzahl der Patienten mit autoimmuner Hepatitis erreicht innerhalb der ersten 3 Monate nach Therapiebeginn eine komplette Remission. Allerdings ist meist eine Langzeittherapie notwendig, die als niedrig dosierte Kombinationstherapie gut vertragen wird. Die Langzeitprognose von Patienten mit autoimmuner Hepatitis ist bei entsprechender Patientenführung exzellent.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".