High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation
The results of the study ‘High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation’ by Pape et al. were accepted in Liver International, and posted online ahead of print.
The study is a collaborative effort of many ERN RARE-LIVER centers with special interest in autoimmune liver diseases. The study focuses on two strategies for azathioprine (AZA) introduction: concurrent with steroids at induction (within 2 weeks) or delayed (by 2 to 24 weeks).
The authors performed a large retrospective cohort study with 900 AIH patients from 12 centers in seven countries in Europe. Primary outcome was percentage of patients who discontinued AZA in the first year of treatment. Discontinuation rates of AZA did not differ between early and delayed starters (16.6% vs. 14.2%), which did not reach statistical significance (hazard ratio 0.97, 95% confidence interval 0.61 – 1.55, p =0.90). In both groups most patients discontinued AZA due to intolerance to treatment (14.0% vs. 13.2%, p = 0.78). AIH remission rates were comparable among groups (week 26: 57.5% vs. 54.2%, p = 0.53; week 52: 66.4% vs. 66.7%, p = 0.96).
The authors conclude that the discontinuation rate of AZA in AIH treatment is 15,1% in the first year of treatment with nausea and vomiting as main side-effects, suggesting that early (<2 weeks) or delayed (≥2 weeks) AZA initiation do not differ in remission and discontinuation rates in AIH induction therapy.
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.