Various Regimens for Autoimmune Hepatitis in Northern European Children Show Equivalent Outcomes at 1 Year: A Retrospective Study

OBJECTIVE: To compare the remission rates after 1 year of treatment between two regimens: tacrolimus (with or without prednisolone) or prednisolone (with or without azathioprine) in children with autoimmune liver disease.

STUDY DESIGN: Retrospective data from children (n = 157) with biopsy-proven autoimmune liver disease in five tertiary northern European centers were included. Data were collected at presentation and after 3, 6, and 12 months.

RESULTS: Initially, 111 were treated with prednisolone (with or without azathioprine) and 46 received tacrolimus (with or without prednisolone) (median start dose prednisolone: 0.99 mg/kg and 0.43 mg/kg, respectively). At diagnosis, alanine transaminase levels were similar, but the rate of advanced fibrosis was significantly higher in the tacrolimus (with or without prednisolone) group. Lower rates of alanine transaminase normalization in the tacrolimus (with or without prednisolone) group were found at 3 months (26.8 vs 58.0%, P < .001) and 6 months (46.2% vs 68.8, P = .014), but not at 1 year (68.2 vs 76.2%, P > .05). The same pattern was seen for immunoglobulin G.

CONCLUSION: Despite slower treatment response for patients initially started on tacrolimus (with or without prednisolone) at 3 and 6 months, biochemical and immunological responses to the two different regimens appeared equivalent at 1 year after treatment initiation.