https://www.ncbi.nlm.nih.gov/pubmed/28272159

Sheiko MA, Sundaram SS, Capocelli KE, Pan Z, McCoy AM, Mack CL. J Pediatr Gastroenterol Nutr. 2017 Mar 7.

Abstract

OBJECTIVES:
Autoimmune hepatitis (AIH) is a common pediatric liver disease and long-term remission is usually maintained with azathioprine (AZA). There is no consensus on the target range for AZA active metabolite 6-thioguanine (6-TGN) levels in pediatric AIH. The aim of this study was to characterize the outcomes of pediatric patients with AIH and determine correlations between AZA dosing or 6-TGN metabolite levels and biochemical remission.

METHODS:
A retrospective chart review was performed and data on presentation, laboratories including AZA metabolite levels, medication use and outcomes was collected.

RESULTS:
Between 2002-2013, 66 children with AIH were identified (mean age at diagnosis 9.6 ± 5.1 yrs.) with a mean follow-up period of 2.9 ± 3.2 yrs. Common presenting symptoms included jaundice, fatigue and abdominal pain. The majority of subjects received steroids for induction, and AZA for maintenance of remission. 79% achieved biochemical remission (mean time to remission 6.2 ± 9.2 mons.), 14% were in the induction phase of therapy, 6% required liver transplantation and 18% were weaned off of immunosuppression and remained in remission. 6-TGN levels ranging from 50-250 pmol/8 × 10 RBC were associated with biochemical remission (ALT levels of ≤ 50 U/L).

CONCLUSIONS:
The vast majority of children with AIH maintain a sustained remission with AZA monotherapy. Biochemical remission was maintained with 6-TGN levels much lower than that recommended for inflammatory bowel disease. These findings suggest that patients should be maintained at the lowest AZA dose possible that is associated with biochemical remission.

Published on: 
Mar-2017

CLF Intro movie

Financial Aid Offered by Trusts

Follow us on: