TY - JOUR
T1 - Aminotransferases During Treatment Predict Long-Term Survival in Patients With Autoimmune Hepatitis Type 1
T2 - A Landmark Analysis
AU - Biewenga, Maaike
AU - Verhelst, Xavier
AU - Dutch Autoimmune Hepatitis Study Group
AU - Baven-Pronk, Martine
AU - Putter, Hein
AU - van den Berg, Aad
AU - Colle, Isabelle
AU - Schouten, Jeoffrey
AU - Sermon, Filip
AU - Van Steenkiste, Christophe
AU - van Vlierberghe, Hans
AU - van der Meer, Adriaan
AU - van Hoek, Bart
AU - Bouma, G.
AU - de Boer, Y.
AU - Drenth, J. P.H.
AU - van Gerven, N. M.
AU - Beuers, U.
AU - van Erpecum, K. J.
AU - den Ouden, J. W.
AU - Bhalla, A.
AU - Brouwer, J. T.
AU - Vrolijk, J. M.
AU - Koek, G. H.
AU - Guichelaar, M. M.J.
AU - van der Wouden, E. J.
AU - van Meyel, J. J.M.
AU - Baak, L. C.
AU - Verdonk, R. C.
AU - Klemt-Kropp, M.
AU - Verhagen, M. A.M.T.
AU - Kuijvenhoven, J. Ph
AU - de Jonge, H. M.
N1 - Funding:
Maaike Biewenga was supported by an unrestricted grant from Zambon Pharma.
Publisher Copyright: © 2021 AGA Institute
PY - 2021/5/19
Y1 - 2021/5/19
N2 - Background & Aims: Biochemical remission, important treatment goal in autoimmune hepatitis (AIH), has been associated with better long-term survival. The aim of this study was to determine the independent prognostic value of aminotransferases and immunoglobulin G (IgG) during treatment on long-term transplant-free survival in AIH. Methods: In a multicenter cohort alanine aminotransferase, aspartate aminotransferase (AST), and IgG were collected at diagnosis and 6, 12, 24, and 36 months after start of therapy and related to long-term outcome using Kaplan-Meier survival and Cox regression analysis with landmark analysis at these time points, excluding patients with follow-up ending before each landmark. Results: A total of 301 AIH patients with a median follow-up of 99 (range, 7–438) months were included. During follow-up, 15 patients required liver transplantation and 33 patients died. Higher AST at 12 months was associated with worse survival (hazard ratio [HR], 1.86; P < .001), while IgG was not associated with survival (HR, 1.30; P = .53). In multivariate analysis AST at 12 months (HR, 2.13; P < .001) was predictive for survival independent of age, AST at diagnosis and cirrhosis. Multivariate analysis for AST yielded similar results at 6 months (HR, 2.61; P = .001), 24 months (HR, 2.93; P = .003), and 36 months (HR, 3.03; P = .010). There was a trend toward a worse survival in patients with mildly elevated aminotransferases (1–1.5× upper limit of normal) compared with patients with normal aminotransferases (P = .097). Conclusions: Low aminotransferases during treatment are associated with a better long-term survival in autoimmune hepatitis. IgG was not associated with survival in first 12 months of treatment. Normalization of aminotransferases should be the treatment goal for autoimmune hepatitis to improve long-term survival.
AB - Background & Aims: Biochemical remission, important treatment goal in autoimmune hepatitis (AIH), has been associated with better long-term survival. The aim of this study was to determine the independent prognostic value of aminotransferases and immunoglobulin G (IgG) during treatment on long-term transplant-free survival in AIH. Methods: In a multicenter cohort alanine aminotransferase, aspartate aminotransferase (AST), and IgG were collected at diagnosis and 6, 12, 24, and 36 months after start of therapy and related to long-term outcome using Kaplan-Meier survival and Cox regression analysis with landmark analysis at these time points, excluding patients with follow-up ending before each landmark. Results: A total of 301 AIH patients with a median follow-up of 99 (range, 7–438) months were included. During follow-up, 15 patients required liver transplantation and 33 patients died. Higher AST at 12 months was associated with worse survival (hazard ratio [HR], 1.86; P < .001), while IgG was not associated with survival (HR, 1.30; P = .53). In multivariate analysis AST at 12 months (HR, 2.13; P < .001) was predictive for survival independent of age, AST at diagnosis and cirrhosis. Multivariate analysis for AST yielded similar results at 6 months (HR, 2.61; P = .001), 24 months (HR, 2.93; P = .003), and 36 months (HR, 3.03; P = .010). There was a trend toward a worse survival in patients with mildly elevated aminotransferases (1–1.5× upper limit of normal) compared with patients with normal aminotransferases (P = .097). Conclusions: Low aminotransferases during treatment are associated with a better long-term survival in autoimmune hepatitis. IgG was not associated with survival in first 12 months of treatment. Normalization of aminotransferases should be the treatment goal for autoimmune hepatitis to improve long-term survival.
UR - http://www.scopus.com/inward/record.url?scp=85110425287&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2021.05.024
DO - 10.1016/j.cgh.2021.05.024
M3 - Article
C2 - 34022454
AN - SCOPUS:85110425287
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
ER -