The Role of Pathological Staging in Selection of Appropriate Treatment Option for Autoimmune Hepatitis: Findings of a prospective Observational Study

Background This prospective study was designed to examine the role of fibrosis staging on selection and success of treatment options for autoimmune hepatitis (AIH). Materials and Methods The project was conducted on 110 selected AIH patients who, based on the results of liver biopsy, had been assigned into one of the three groups (mild, stages 1 and 2, moderate, stages 3 and 4, and severe, stages 5 and 6 fibrosis). The patients received prednisolone alone or in combination with azathioprine and the response to the treatment were assessed. Results The number of patients who were identified to have mild, moderate and severe fibrosis were 34 (31%), 35 (32%), and 41 (37%), respectively. Of 110 patients, 56 patients (51%) received prednisolone alone and 54 patients (49%) received combined drugs protocol. In total, 77 patients (70%) showed response to the treatment. The response rate for both modalities was much lower in the third group (P<0.05). However, compared to the prednisolone single therapy, the response rate of combination therapy was higher in this group. Conclusion Our results clearly showed that response to treatment in AIH patients is decreased as hepatic fibrosis becomes more severe. Our findings indicate that pathological staging could navigate the selection of appropriate therapy, i.e. prednisolone alone is used for mild and moderate fibrosis while combination therapy is reserved for severe cases.

Keywords:

Autoimmune hepatitis , Liver fibrosis , Treatment regimen