Dosing and Route of Steroid Induction Therapy in Non-Severe Autoimmune Hepatitis Do Not Affect Time to Biochemical...

Optimal steroid induction therapy in autoimmune hepatitis (AIH) is unclear. We aimed to investigate the relationship between steroid dosing, route of administration, and time to biochemical response to help standardize AIH practice patterns and reduce excess steroid exposure.

We conducted a retrospective cohort study of adult patients with non-severe AIH receiving induction steroid therapy. Patients were stratified into three treatment groups: (1) low-dose oral steroids (n = 39; prednisone < 40 mg/day or budesonide 9 mg/day), (2) high-dose oral steroids (n = 32; prednisone 40 mg/day), and (3) intravenous steroids (n = 21; methylprednisolone 1 g/day). Time to biochemical response and predictors of biochemical response were compared at 6- and 12-month intervals.

Rates of biochemical response were similar between the low- and high-dose oral steroid groups at 6 months (72% vs. 78%, p = 0.54) and 12 months (92% vs. 91%, p = 1.00). Regarding high-dose oral versus IV steroid induction, rates of biochemical response were similar between groups at 6 months (78% vs. 86%, p = 0.72) and 12 months (91% vs. 90%, p = 1.00). Time to biochemical response was not significantly different across all groups at both 6 and 12 months (log-rank test, p = 0.23 and p = 0.42, respectively). Initial biomarkers of disease severity were not predictive of time to biochemical response across groups.

Lower dose prednisone may be an effective initial induction regimen in outpatients with AIH. Similarly, oral steroids may be non-inferior to IV steroids. Together, these results favor a more conservative approach for non-severe AIH induction therapy.