Hepatic safety and efficacy of immunomodulatory drugs used in patients with autoimmune hepatitis.

Journal

Journal of autoimmunity
ISSN: 1095-9157
Titre abrégé: J Autoimmun
Pays: England
ID NLM: 8812164

Informations de publication

Date de publication:
14 Sep 2023
Historique:
received: 11 06 2023
revised: 28 07 2023
accepted: 06 09 2023
medline: 17 9 2023
pubmed: 17 9 2023
entrez: 16 9 2023
Statut: aheadofprint

Résumé

There is little data on the hepatic efficacy and safety of immunomodulatory drugs used in patients with autoimmune hepatitis (AIH), despite their established use in dermatology, rheumatology and inflammatory bowel diseases (IBD). Our aim was to collect real-life data on the experience of expert centres in treating AIH patients with these drugs, considered unconventional for AIH management. Online survey among hepatology centres being part of the European Reference Network on Hepatological Diseases (ERN RARE-LIVER). 25 AIH patients have been reported. Ten were female, median age at diagnosis was 28 years; median follow-up was 17 months. All had initially received AIH-standard treatment. AIH-unconventional treatment was initiated for concomitant autoimmune diseases in 15 cases: nine for IBD (five vedolizumab and four ustekinumab), and one each for following diseases: autoinflammatory syndrome (tocilizumab), chronic urticaria (omalizumab), rheumatoid arthritis (abatacept), psoriasis (guselkumab), psoriatric arthritis (secukinumab, followed by ustekinumab) and alopecia (ruxolitinib). Three patients were treated with immunomodulatory drugs for side effects of previous treatments, including two patients with IBD treated with vedolizumab and ustekinumab, respectively, and one treated with belimumab. At the end of follow-up, 13 patients were in complete biochemical response, the patient on omalizumab had a relapse, and four patients with concomitant IBD had insufficient response. Seven patients were treated for lack of biochemical remission, of whom six with belimumab, all initially reaching complete biochemical response, but five relapsing during follow-up; and one with secukinumab, having concomitant rheumatoid arthritis and ankylosing spondylitis, reaching complete biochemical response. Only the patient on abatacept received unconventional treatment as monotherapy. Side effects were reported in two patients on belimumab: one recurrent soft tissue infections, one fatigue and arthralgia. Among 25 AIH patients who were treated with immunomodulatory drugs for different reasons, the majority had a fovorable course, relapse was frequent in difficult-to-treat patients who received belimumab, and four with concomitant IBD had insufficient response.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
There is little data on the hepatic efficacy and safety of immunomodulatory drugs used in patients with autoimmune hepatitis (AIH), despite their established use in dermatology, rheumatology and inflammatory bowel diseases (IBD). Our aim was to collect real-life data on the experience of expert centres in treating AIH patients with these drugs, considered unconventional for AIH management.
METHODS METHODS
Online survey among hepatology centres being part of the European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
RESULTS RESULTS
25 AIH patients have been reported. Ten were female, median age at diagnosis was 28 years; median follow-up was 17 months. All had initially received AIH-standard treatment. AIH-unconventional treatment was initiated for concomitant autoimmune diseases in 15 cases: nine for IBD (five vedolizumab and four ustekinumab), and one each for following diseases: autoinflammatory syndrome (tocilizumab), chronic urticaria (omalizumab), rheumatoid arthritis (abatacept), psoriasis (guselkumab), psoriatric arthritis (secukinumab, followed by ustekinumab) and alopecia (ruxolitinib). Three patients were treated with immunomodulatory drugs for side effects of previous treatments, including two patients with IBD treated with vedolizumab and ustekinumab, respectively, and one treated with belimumab. At the end of follow-up, 13 patients were in complete biochemical response, the patient on omalizumab had a relapse, and four patients with concomitant IBD had insufficient response. Seven patients were treated for lack of biochemical remission, of whom six with belimumab, all initially reaching complete biochemical response, but five relapsing during follow-up; and one with secukinumab, having concomitant rheumatoid arthritis and ankylosing spondylitis, reaching complete biochemical response. Only the patient on abatacept received unconventional treatment as monotherapy. Side effects were reported in two patients on belimumab: one recurrent soft tissue infections, one fatigue and arthralgia.
CONCLUSION CONCLUSIONS
Among 25 AIH patients who were treated with immunomodulatory drugs for different reasons, the majority had a fovorable course, relapse was frequent in difficult-to-treat patients who received belimumab, and four with concomitant IBD had insufficient response.

Identifiants

DOI: 10.1016/j.jaut.2023.103113 PMID: 37716078
pubmed: 37716078
pii: S0896-8411(23)00122-1
doi: 10.1016/j.jaut.2023.103113
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103113

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Benedetta Terziroli Beretta-Piccoli (B)

Epatocentro Ticino, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK. Electronic address: benedetta.terziroli@usi.ch.

Gustav Buescher (G)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

George Dalekos (G)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.

Kalliopi Zachou (K)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.

Anja Geerts (A)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Gastroenterology and Hepatology, University Hospital of Ghent, Belgium.

Nasser Semmo (N)

Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland.

Mirjam Kolev (M)

Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland.

Eleonora De Martin (E)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hépatologie et Transplantation Hépatique, Hôpital Paul Brousse, Villejuif, France.

Maciej K Janik (MK)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; . Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.

João Madaleno (J)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Liver Disease Unit, Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Milica Lalosevic Stojkovic (M)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; University Clinical Center of Serbia, Belgrade, Serbia.

Jérôme Dumortier (J)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hôpital Edouard Herriot, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France.

Thomas Vanwolleghem (T)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Gastroenterology and Hepatology Antwerp University Hospital, Antwerp, Belgium; Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Antwerp, Belgium.

Ida Schregel (I)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Silja Steinmann (S)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Florence Lacaille (F)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hôpital Necker-Enfants Malades, Paris, France.

Marcial Sebode (M)

European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Classifications MeSH