AI Article Synopsis

  • Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) can occur together in a condition known as AIH-PBC, requiring a combined treatment approach with immunosuppressants and ursodeoxycholic acid (UDCA), while the Paris and Zhang criteria are used to diagnose these patients.
  • In a study of 83 patients suspected to have AIH-PBC, the Zhang criteria were more commonly fulfilled (70%) compared to the Paris criteria (24%), with those meeting both criteria showing more severe liver histology.
  • The study found that patients treated as AIH-PBC had good long-term outcomes, indicating that identifying individuals outside the established criteria may still benefit from combination therapy, especially compared

Article Abstract

Background & Aims: Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) can co-exist in AIH-PBC, requiring combined treatment with immunosuppression and ursodeoxycholic acid (UDCA). The Paris criteria are commonly used to identify these patients; however, the optimal diagnostic criteria are unknown. We aimed to evaluate the use and clinical relevance of both Paris and Zhang criteria.

Methods: Eighty-three patients with a clinical suspicion of AIH-PBC who were treated with combination therapy were included. Histology was re-evaluated. Characteristics and long-term outcomes were retrospectively compared to patients with AIH and PBC.

Results: Seventeen (24%) patients treated with combination therapy fulfilled the Paris criteria. Fifty-two patients (70%) fulfilled the Zhang criteria. Patients who met Paris and Zhang criteria more often had inflammation and fibrosis on histology compared to patients only meeting the Zhang criteria. Ten-year liver transplant (LT)-free survival was 87.3% (95% CI 78.9-95.7%) in patients with AIH-PBC. This did not differ in patients in or outside the Paris or Zhang criteria ( 0.46 and 0.40, respectively) or from AIH ( 0.086). LT-free survival was significantly lower in patients with PBC and severe hepatic inflammation - not receiving immunosuppression - compared to those with AIH-PBC (65%; 95% CI 52.2-77.8% . 87%; 95% CI 83.2-90.8%; hazard ratio 0.52; 0.043).

Conclusions: In this study, patients with AIH-PBC outside Paris or Zhang criteria were frequently labeled as having AIH-PBC and were successfully treated with combination therapy with similar outcomes. LT-free survival was worse in patients with PBC and hepatic inflammation than in those treated as having AIH-PBC. More patients may benefit from combination therapy.

Impact And Implications: This study demonstrated that patients with AIH-PBC variant syndrome treated with combined therapy consisting of immunosuppressants and ursodeoxycholic acid often do not fulfill the Paris criteria. They do however have comparable response to therapy and long-term outcomes as patients who do fulfill the diagnostic criteria. Additionally, patients with PBC and additional signs of hepatic inflammation have poorer long-term outcomes compared to patients treated as having AIH-PBC. These results implicate that a larger group of patients with features of both AIH and PBC may benefit from combined treatment. With our results, we call for improved consensus among experts in the field on the diagnosis and management of AIH-PBC variant syndrome.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11225825PMC
http://dx.doi.org/10.1016/j.jhepr.2024.101088DOI Listing

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