The study is a collaborative effort of many ERN RARE-LIVER centers with special interest in autoimmune liver diseases. The study focuses on transaminase-dynamics and its possible relation to long-term clinical outcomes in a large retrospective cohort, which was split in a discovery (n=370) and validation cohort (n=370). The authors hypothesized that patients with a rapid decrease in transaminases have a higher probability to achieve biochemical remission and a lower risk for liver-related morbidity.
An 80% decrease in aspartate aminotransferase (AST) after 8 weeks was calculated as cutoff to classify patients as ‘rapid responders’. Rapid responders were more likely to achieve normalization of transaminases at 26 and 52 weeks, and may have a lower risk of liver-related death and/or transplantation, but this was not confirmed in the validation cohort. The authors conclude that a considerable and swift decrease in AST may be a predictor of a favorable long-term disease course, which accords with other studies.
The authors provide three clinical recommendations: (1) The absence of rapid response could be used to identify patients that might benefit from intensified monitoring and escalation of treatment. (2) As a large portion of patients without rapid response ultimately achieve biochemical remission, clinicians should be encouraged to continue adequate immunosuppression in these patients. (3) Patients should be monitored intensively during the first weeks of treatment, this will result in a good understanding of transaminase-dynamics and long-term risks.

Lucas Bernts
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Contact: lucas.bernts@radboudumc.nl