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Adverse events related to low dose corticosteroids in autoimmune hepatitis

Dutch Autoimmune Hepatitis Study G, van den Brand, F. F., van der Veen, K. S., Lissenberg-Witte, B., de Boer, Y. S., van Hoek, B., Drenth, J. P. H., Verdonk, R. C., Vrolijk, J. M., van Nieuwkerk, C. M. J. & Bouma, G., 15-Oct-2019, In : Alimentary Pharmacology & Therapeutics. 7 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • Dutch Autoimmune Hepatitis Study G
  • Floris F. van den Brand
  • Koen S. van der Veen
  • Birgit Lissenberg-Witte
  • Ynto S. de Boer
  • Bart van Hoek
  • Joost P. H. Drenth
  • Robert C. Verdonk
  • Jan M. Vrolijk
  • Carin M. J. van Nieuwkerk
  • Gerd Bouma

Background Autoimmune hepatitis requires long-term therapy, and systemic corticosteroids are the backbone of therapeutic management. Prolonged use of corticosteroids may lead to adverse events but data from long-term studies are mainly derived from studies in rheumatic diseases. Aim To assess cataract, diabetes and fractures in relation to corticosteroid doses in the long-term maintenance treatment of patients with autoimmune hepatitis. Methods We retrospectively collected data on 476 patients (77% women) with an established diagnosis of autoimmune hepatitis. Binary logistic regression with a generalised estimating equation was used to analyse the association between current corticosteroid use and the incidence of cataract, diabetes and fractures with onset after autoimmune hepatitis diagnosis. We corrected for sex, age, cirrhosis at diagnosis and predniso(lo)ne use in the prior 3 years to account for possible ongoing effects. Results A total of 6634 years, with a median of 13 (range 1-40) per patient were recorded. The median age at diagnosis was 44 years (range 2-88). Adverse events were documented in 120 (25%) patients. Low-dose predniso(lo)ne (0.1-5.0 mg/d) increased the odds of fractures whereas higher doses (>5.0 mg/d) increased the odds of cataracts and diabetes. Budesonide increased the odds of cataract and fractures; this effect was independent of predniso(lo)ne use in the prior 1, 2 or 3 years. Conclusions Even low doses of corticosteroids frequently lead to substantial adverse events refuting the assumption that adverse events are prevented by administering low doses.

Original languageEnglish
Number of pages7
JournalAlimentary Pharmacology & Therapeutics
Publication statusPublished - 15-Oct-2019

    Keywords

  • ACTIVE LIVER-DISEASE, CONTROLLED-TRIAL, AZATHIOPRINE, BUDESONIDE, REMISSION, PREDNISONE, WITHDRAWAL, EFFICACY, THERAPY

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