Spotlight on autoimmune hepatitis

One study compared the hospitalization rate for autoimmune hepatitis among black, Latino, and Asian/Pacific Islander patients versus a reference rate among white patients, while another study retrospectively analyzed budesonide as a second-line agent in patients with autoimmune hepatitis initially treated with prednisolone.


A recent study uncovered racial disparities in national hospitalization rates for autoimmune hepatitis, while another found that budesonide may be a viable second-line treatment for the disease.

In the first study, researchers used data from the National Inpatient Sample between 2008 and 2012 to compare the hospitalization rate for autoimmune hepatitis among black, Latino, and Asian/Pacific Islander patients versus a reference rate among white patients. Results were published online on Jan. 30 by the American Journal of Gastroenterology.

Overall, the national rate of hospitalization for the disease was 0.73 hospital admissions per 100,000 population. Compared to white patients, black patients were hospitalized at a 69% higher rate (95% CI, 1.58 to 1.81), and Latino patients were hospitalized at a 20% higher rate (95% CI, 1.12 to 1.28). Asians and Pacific Islanders had a 64% lower hospitalization rate than whites (95% CI, 0.29 to 0.43). After adjustment for various socioeconomic factors, black race (but no other race) significantly increased the odds of death for patients hospitalized for autoimmune hepatitis (odds ratio, 2.81 [95% CI, 1.43 to 5.47]; P<0.01).

The study authors noted limitations of their analysis, such as a lack of personal identification information on discharge records, meaning that the same patient could have been hospitalized for the disease multiple times. They added that the disease did not receive a specific ICD-9 code until 2008. “Future studies should further elucidate the reasons behind these racial disparities in order to design targeted interventions, particularly as the number of people of color in the United States grows,” the authors concluded.

The second study retrospectively analyzed budesonide as a second-line agent in 60 patients with autoimmune hepatitis who were initially treated with prednisolone for an average of 47 months. Results were published online on Jan. 23 by Clinical Gastroenterology and Hepatology.

Thirty patients had switched to budesonide because of side effects related to prednisolone, and 30 switched after developing prednisolone dependency. Overall, 55% of patients had a biochemical response after six months of budesonide treatment, 70% had a response after 12 months, and 67% had a response after 24 months. At the end of a mean 63 months of follow-up, 23 (38%) patients continued to receive budesonide treatment, while 15 (25%) patients had switched back to prednisolone due to side effects or an insufficient response to budesonide. In 15 patients who had follow-up dual-energy X-ray absorptiometry scans performed a median 24 months after the initial measurement, bone mineral density improved in six, was stable in eight, and deteriorated in one.

The study authors noted that limitations of the analysis include its retrospective, single-center nature and the fact that they could not perform a systematic assessment of budesonide-induced side effects. They concluded that the efficacy and safety profile seen in the cohort support the role of budesonide as an alternative treatment option in patients without cirrhosis. “However, treatment efficacy and tolerance must be monitored because efficacy of budesonide may not suffice to maintain remission or control concomitant autoimmune disease and budesonide-induced side effects may occur in patients even in the absence of cirrhosis,” they wrote.