Expert clinical management of autoimmune hepatitis in the real world

摘要: SummaryBackground High-quality data on the management of autoimmune hepatitis (AIH) are scarce. Despite published guidelines, AIH is still expert based rather than evidence based. Aim To survey hepatologists, asking each to describe their practices in patients with AIH. Methods A questionnaire was distributed members International Group. The consisted four clinical scenarios different presentations AIH. Results Sixty surveys were sent, out which 37 returned. None reported budesonide as a first line induction agent for acute presentation AIH. Five (14%) participants using thiopurine S-methyltransferase measurements before commencement maintenance therapy. Thirteen (35%) routinely perform liver biopsy at 2 years biochemical remission. If histological inflammatory activity absent, (11%) reduced azathioprine, whereas 10 (27%) attempted withdrawal altogether. Regarding difficult-to-treat patients, mycophenolate mofetil most widely used second-line (n = ~450 28 centres), tacrolimus ~115 21 centres) and ciclosporin ~112 18 less often reported. One centre considerable experience infliximab, while rescue therapy rituximab has been tried seven centres. Conclusions There wide variation even among field. Although good quality lacking, there therapies. Future prospective studies should address these issues, so that we move from an expert- evidence- personalised-based care hepatitis.