O9 Efficacy and safety of third-line therapies in autoimmune hepatitis: short- and long-term outcomes from a real-world cohort
Bibliographic record
Abstract
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.
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 | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".