Non-Adherence to Standard Therapy in Autoimmune Hepatitis: Impact of Steroid Use and Over-the-Counter Medications

Non-adherence to treatment may be one of the most important causes for the failure of therapy goals in autoimmune liver diseases (AILD). We aimed to assess factors related to non-adherence in adult non-transplanted patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC).

A cross-sectional online survey was conducted in patients with AILD who were prescribed pharmacotherapy for liver disease. Adherence was defined as skipping their medication less than once a week and never reducing or stopping their medication themselves. Sociodemographic data were analyzed relating to medication and disease-related factors in the context of adherence. Multivariable logistic regression analyses were used to identify factors associated with adherence while adjusting for known confounders. A total of 1097 patients with AILD were included: 444 patients with AIH, 377 with PBC and 276 with PSC. Patients with AIH were the most non-adherent group (47%), in comparison to those suffering from PBC (29%), and PSC (38%). In multivariable logistic regression models, over-the-counter medication use was identified as one important common factor that was negatively associated with treatment adherence in all patients and most relevant in the case of the AIH group. Among standard treatments, steroids, though not azathioprine, were negatively associated with adherence in the AIH group.

This anonymous survey revealed high non-adherence in patients with AILD, particularly those with AIH treated with steroids. Over-the-counter medication intake may reflect low treatment confidence in standard treatments and should be carefully assessed in patients with AILD in a clinical setting.