Sistema de Salut de Catalunya
Institut Català de la Salut
[Riveiro-Barciela M] Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain. European Reference Network on Hepatological Diseases (ERN RARELIVER), Eppendorf, Germany. [Barreira-Díaz A, Ruiz-Cobo JC] Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Esteban P] Servei d’Hepatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Rota R] Liver Unit, Gastroenterology Department, Hospital Universitario de Bellvitge, IDIBELL, L'hospitalet, Spain. [Álvarez-Navascúes C] Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. [Pérez-Medrano I] Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
Vall d'Hebron Barcelona Hospital Campus
2024-09-27T12:06:10Z
2024-09-27T12:06:10Z
2024-09
Anti‐CD20 monoclonal antibodies; Autoimmune hepatitis; Corticosteroids
Anticuerpos monoclonales anti‐CD20; Hepatitis autoinmune; Corticosteroides
Anticossos monoclonals anti-CD20; Hepatitis autoimmune; Corticoides
Background and Aims Small series suggest that rituximab could be effective as treatment for autoimmune hepatitis (AIH), although data are scarce. We aimed to evaluate the efficacy and safety of rituximab in different cohorts of patients with AIH. Methods Multicentre retrospective analysis of the 35 patients with AIH and its variant forms treated with rituximab and included in the ColHai registry between 2015 and 2023. Results Most patients were female (83%), 10 (29%) had cirrhosis and four (11.4%) variant forms of AIH. Indication for rituximab were as follows: 14(40%) refractory AIH, 19(54%) concomitant autoimmune or haematological disorder, 2(6%) intolerance to prior treatments. In three (9%) subjects with a concomitant disorder, rituximab was the first therapy for AIH. Overall, 31 (89%) patients achieved or maintained complete biochemical response (CBR), including the three in first-line therapy. No difference in CBR was observed according to rituximab indication (refractory AIH 86% vs. concomitant disorders 90%, p = .824) or cirrhosis (80% vs. 92%, p = .319). Rituximab was associated with a significant reduction in corticosteroids (median dose: prior 20 vs. post 5 mg, p < .001) and the discontinuation of ≥1 immunosuppressant in 47% of patients. Flare-free rate at 1st, 2nd and 3rd year was 86%, 73% and 62% respectively. Flares were not associated with the development of liver failure and were successfully managed with repeated doses of rituximab and/or increased corticosteroids. Three (9%) patients experienced infusion-related adverse events (1 anaphylaxis and 2 flu-like symptoms) and five (14%) infections. Conclusion Rituximab is safe and effective in patients with refractory AIH and those treated due to concomitant autoimmune or haematological disorders.
Article
Published version
English
Avaluació de resultats (Assistència sanitària); Hepatitis - Tractament; Anticossos monoclonals - Ús terapèutic; Hepatitis - Aspectes immunològics; DISEASES::Digestive System Diseases::Liver Diseases::Hepatitis::Hepatitis, Chronic::Hepatitis, Autoimmune; Other subheadings::Other subheadings::Other subheadings::/drug therapy; CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal; Other subheadings::Other subheadings::/therapeutic use; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::hepatitis::hepatitis crónica::hepatitis autoinmune; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas::anticuerpos::anticuerpos monoclonales; Otros calificadores::Otros calificadores::/uso terapéutico; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento
Wiley
Liver International;44(9)
https://doi.org/10.1111/liv.15970
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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