Comparing efficacy between regimens in the initial treatment of autoimmune hepatitis

Autoimmune hepatitis is a chronic syndrome characterized by auto immunologic features generally including the presence of circulating auto antibodies and high serum globulin concentrations. The American Association for the Study of Liver Diseases (AASLD) recommends initial treatment or induction therapy for autoimmune hepatitis to involve a glucocorticoid alone or a combination of a glucocorticoid and an immunosuppressant. The objective of this study is to review and compare the efficacy of the treatment regimens described above among patients diagnosed with and treated for autoimmune hepatitis over the past 10 years in our center which is a major university based hospital.

We retrospectively identified patients above the age of 18 years diagnosed with autoimmune hepatitis in our center between February, 2003 and February, 2013 using the ICD-9 code 571.42. The primary outcome of our study was efficacy of the treatment regimen. We defined efficacy by considering 3 scenarios: Complete Resolution, Incomplete Resolution and Treatment Failure.

We found differences among 3 treatment groups: patients who received Prednisone and immunosuppressant from the beginning of their treatment course, patients who had an immunosuppressant introduced after about 4 weeks on Prednisone and patients who were placed on Prednisone alone.

From our study, better efficacy was achieved in the induction phase using a combination of Prednisone and Azathioprine from the beginning of the treatment course.