TY - JOUR
T1 - Inequity of care provision and outcome disparity in autoimmune hepatitis in the United Kingdom
AU - the UK-AIH Consortium
AU - Dyson, Jessica K.
AU - Wong, Lin Lee
AU - Bigirumurame, Theophile
AU - Hirschfield, Gideon M.
AU - Kendrick, Stuart
AU - Oo, Ye H.
AU - Lohse, Ansgar W.
AU - Heneghan, Michael A.
AU - Jones, David E.J.
AU - English, Shirley
AU - Alexander, Graeme
AU - Mells, George
AU - Majumdar, Debabrata
AU - Sathyanarayana, Vinay
AU - Ramage, John
AU - Shorrock, Christopher
AU - Maggs, James
AU - Elphick, David
AU - Macdonald, Chris
AU - Cramp, Matthew
AU - Sayer, Joanne
AU - Jupp, James
AU - Dyson, Jessica
AU - Hollywood, Coral
AU - Daley, Alexandra
AU - Corless, Lynsey
AU - Craig, Darren
AU - Collier, Jane
AU - Heneghan, Michael A.
AU - Misra, Sharat
AU - Corbett, Chris
AU - Dillon, John
AU - Rushbrook, Simon
AU - Lee, Thomas
AU - Sharaer, Nicholas M.
AU - Rye, Kara
AU - Fowell, Andrew
AU - Broad, Andrea
AU - Mansour, Dina
AU - Douds, Andy
AU - Ryder, Stephen
AU - Keld, Richard
AU - Williams, Earl
AU - Stableforth, William
AU - Austin, Andrew
AU - Gleeson, Dermot
AU - Simpson, Kenneth
AU - Patanwala, Imran
AU - Brind, Alison
AU - Jones, Rebecca
PY - 2018/11
Y1 - 2018/11
N2 - Background: Treatment paradigms in autoimmune hepatitis (AIH) have remained largely unchanged for decades. Studies report ≤20% of patients have sub-optimal treatment response with most requiring long-term therapy. Aim: The United Kingdom Autoimmune Hepatitis (UK-AIH) study was established to evaluate current treatment practice and outcomes, determine the unmet needs of patients, and develop and implement improved treatment approaches. Methods: The United Kingdom Autoimmune Hepatitis study is a cross-sectional cohort study examining secondary care management of prevalent adult patients with a clinical diagnosis of autoimmune hepatitis. Enrolment began in March 2014. Prevalent cases were defined as having been diagnosed and treated for >1 year. Demographic data, biochemistry, treatment history and response, and care location were collected. Results: In total, 1249 patients were recruited; 635 were cared for in transplant units and 614 in non-transplant centres (81% female with median age at diagnosis 50 years). Overall, 29 treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant compared to non-transplant centres (62 vs 55%, P = 0.028). 55% have ongoing corticosteroid exposure; 9% are receiving prednisolone monotherapy. Those aged ≤20 years at diagnosis were more likely to develop cirrhosis and place of care was associated with an aggressive disease phenotype. Conclusions: There are significant discrepancies in the care received by patients with autoimmune hepatitis in the UK. A high proportion remains on corticosteroids and there is significant treatment variability. Patients receiving care in transplant centres were more likely to achieve and maintain remission. Overall poor remission rates suggest that there are significant unmet therapeutic needs for patients with autoimmune hepatitis.
AB - Background: Treatment paradigms in autoimmune hepatitis (AIH) have remained largely unchanged for decades. Studies report ≤20% of patients have sub-optimal treatment response with most requiring long-term therapy. Aim: The United Kingdom Autoimmune Hepatitis (UK-AIH) study was established to evaluate current treatment practice and outcomes, determine the unmet needs of patients, and develop and implement improved treatment approaches. Methods: The United Kingdom Autoimmune Hepatitis study is a cross-sectional cohort study examining secondary care management of prevalent adult patients with a clinical diagnosis of autoimmune hepatitis. Enrolment began in March 2014. Prevalent cases were defined as having been diagnosed and treated for >1 year. Demographic data, biochemistry, treatment history and response, and care location were collected. Results: In total, 1249 patients were recruited; 635 were cared for in transplant units and 614 in non-transplant centres (81% female with median age at diagnosis 50 years). Overall, 29 treatment regimens were reported and biochemical remission rate was 59%. Remission rates were significantly higher in transplant compared to non-transplant centres (62 vs 55%, P = 0.028). 55% have ongoing corticosteroid exposure; 9% are receiving prednisolone monotherapy. Those aged ≤20 years at diagnosis were more likely to develop cirrhosis and place of care was associated with an aggressive disease phenotype. Conclusions: There are significant discrepancies in the care received by patients with autoimmune hepatitis in the UK. A high proportion remains on corticosteroids and there is significant treatment variability. Patients receiving care in transplant centres were more likely to achieve and maintain remission. Overall poor remission rates suggest that there are significant unmet therapeutic needs for patients with autoimmune hepatitis.
UR - http://www.scopus.com/inward/record.url?scp=85053533063&partnerID=8YFLogxK
U2 - 10.1111/apt.14968
DO - 10.1111/apt.14968
M3 - Article
C2 - 30226274
AN - SCOPUS:85053533063
SN - 0269-2813
VL - 48
SP - 951
EP - 960
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
IS - 9
ER -