Categorías
Valdecilla

Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration

Authors: Díaz-González Á, Hernández-Guerra M, Pérez-Medrano I, Sapena V, Riveiro-Barciela M, Barreira-Díaz A, Gómez E, Morillas RM, Del Barrio M, Escudé L, Mateos B, Horta D, Gómez J, Conde I, Ferre-Aracil C, El Hajra I, Arencibía A, Zamora J, Fernández A, Salcedo M, Molina E, Soria A, Estévez P, López C, Álvarez-Navascúes C, García-Retortillo M, Crespo J, Londoño MC; ColHai Registry.

Hepatology. 2023 Jan 3. doi: 10.1097/HEP.0000000000000018. Online ahead of print.

Abstract

Background and aims: In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options.

Approach and results: This was a retrospective, multicenter study of 105 naive AIH patients treated with budesonide as the first-line drug. The control group included 276 patients treated with prednisone. Efficacy was assessed using logistic regression and validated using inverse probability of treatment weighting propensity score. The median time to biochemical response (BR) was 3.1 months in patients treated with budesonide and 4.9 months in those with prednisone. The BR rate was significantly higher in patients treated with prednisone (87% vs. 49% of patients with budesonide, p < 0.001). The probability of achieving BR, assessed using the inverse probability of treatment weighting propensity score, was significantly lower in the budesonide group (OR = 0.20; 95% CI: 0.11-0.38) at any time during follow-up, and at 6 (OR = 0.51; 95% CI: 0.29-0.89) and 12 months after starting treatment (0.41; 95% CI: 0.23-0.73). In patients with transaminases <2 × upper limit of normal, BR was similar in both treatment groups. Prednisone treatment was significantly associated with a higher risk of adverse events (24.2% vs. 15.9%, p = 0.047).

Conclusions: In the real-life setting, the use of budesonide as first-line treatment is low, and it is generally prescribed to patients with perceived less disease activity. Budesonide was inferior to prednisone as a first-line drug but was associated with fewer side effects.

Categorías
Valdecilla

Webinar Registro ColHai de la AEEH – 30 de Marzo 17:00 CET

El grupo de trabajo para enfermedades hepáticas Colestásicas y Autoinmunes –ColHai– presenta un nuevo webinar. Entre sus ponentes se encuentra nuestro compañero y amigo el Dr. Álvaro Díaz González.

Además, cuenta con ponentes de las sociedades para el estudio del hígado de Portugal (APEF) – con el Dr. José Presa y latinoamericana (ALEH) – con la Dra. Alejandra Villamil. Para cerrar este magnífico panel, el Dr. Ulrich Beuers, Amsterdam.

Inscripción gratuita en este enlace.

Consulta el programa aquí.