Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis

Yasuhiro Miyake, Yoshiaki Iwasaki, Haruhiko Kobashi, Tetsuya Yasunaka, Fusao Ikeda, Akinobu Takaki, Ryoichi Okamoto, Kouichi Takaguchi, Hiroshi Ikeda, Yasuhiro Makino, Masaharu Ando, Kohsaku Sakaguchi, Kazuhide Yamamoto

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: This study aimed to investigate the efficacy of ursodeoxycholic acid (UDCA) for Japanese patients with autoimmune hepatitis (AIH). Methods: One hundred forty-seven patients were investigated. Results: As initial treatment, 25 patients received UDCA (300-600 mg/day) monotherapy (UDCA group), 40 received a combination of prednisolone (PSL) (≥20 mg/day) and UDCA (combination group), 68 received PSL monotherapy (PSL group), and 14 received other treatments. During the follow-up, in the UDCA group, PSL was added to 8 of 12 patients failing to achieve the normalization of serum transaminase levels with UDCA monotherapy. Cumulative incidence of the normalization of serum transaminase levels was 64% in the UDCA group, 95% in the combination group, and 94% in the PSL group (log-rank test, P = 0.0001). UDCA group required longest periods until the normalization of serum transaminase levels. Eleven patients, who achieved persistent normalization of serum transaminase levels with UDCA monotherapy, did not reach liver failure or develop hepatocellular carcinoma for 49.7 (range = 13.4-137.3) months. Meanwhile, during the taper of PSL, doses of PSL at the initial relapse were lower in patients treated with PSL and UDCA than in those treated with PSL monotherapy, and initial relapse occurred earlier in patients treated with PSL monotherapy. Conclusions: UDCA monotherapy is effective for some Japanese AIH patients; however, UDCA monotherapy for patients with either high-grade inflammatory activity or poor residual capacity of liver function is not recommended because they may reach liver failure before achievement of remission. Meanwhile, additional use of UDCA during the taper of corticosteroids may be effective for the prevention of early relapse.

Original languageEnglish
Pages (from-to)556-562
Number of pages7
JournalHepatology International
Volume3
Issue number4
DOIs
Publication statusPublished - Dec 2009

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Ursodeoxycholic Acid
Autoimmune Hepatitis
Prednisolone
Transaminases
Liver Failure
Serum
Recurrence
Secondary Prevention
Hepatocellular Carcinoma

Keywords

  • Autoimmune hepatitis
  • Corticosteroid
  • Ursodeoxycholic acid

ASJC Scopus subject areas

  • Hepatology

Cite this

Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis. / Miyake, Yasuhiro; Iwasaki, Yoshiaki; Kobashi, Haruhiko; Yasunaka, Tetsuya; Ikeda, Fusao; Takaki, Akinobu; Okamoto, Ryoichi; Takaguchi, Kouichi; Ikeda, Hiroshi; Makino, Yasuhiro; Ando, Masaharu; Sakaguchi, Kohsaku; Yamamoto, Kazuhide.

In: Hepatology International, Vol. 3, No. 4, 12.2009, p. 556-562.

Research output: Contribution to journalArticle

Miyake, Y, Iwasaki, Y, Kobashi, H, Yasunaka, T, Ikeda, F, Takaki, A, Okamoto, R, Takaguchi, K, Ikeda, H, Makino, Y, Ando, M, Sakaguchi, K & Yamamoto, K 2009, 'Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis', Hepatology International, vol. 3, no. 4, pp. 556-562. https://doi.org/10.1007/s12072-009-9155-9
Miyake, Yasuhiro ; Iwasaki, Yoshiaki ; Kobashi, Haruhiko ; Yasunaka, Tetsuya ; Ikeda, Fusao ; Takaki, Akinobu ; Okamoto, Ryoichi ; Takaguchi, Kouichi ; Ikeda, Hiroshi ; Makino, Yasuhiro ; Ando, Masaharu ; Sakaguchi, Kohsaku ; Yamamoto, Kazuhide. / Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis. In: Hepatology International. 2009 ; Vol. 3, No. 4. pp. 556-562.
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AU - Miyake, Yasuhiro

AU - Iwasaki, Yoshiaki

AU - Kobashi, Haruhiko

AU - Yasunaka, Tetsuya

AU - Ikeda, Fusao

AU - Takaki, Akinobu

AU - Okamoto, Ryoichi

AU - Takaguchi, Kouichi

AU - Ikeda, Hiroshi

AU - Makino, Yasuhiro

AU - Ando, Masaharu

AU - Sakaguchi, Kohsaku

AU - Yamamoto, Kazuhide

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N2 - Purpose: This study aimed to investigate the efficacy of ursodeoxycholic acid (UDCA) for Japanese patients with autoimmune hepatitis (AIH). Methods: One hundred forty-seven patients were investigated. Results: As initial treatment, 25 patients received UDCA (300-600 mg/day) monotherapy (UDCA group), 40 received a combination of prednisolone (PSL) (≥20 mg/day) and UDCA (combination group), 68 received PSL monotherapy (PSL group), and 14 received other treatments. During the follow-up, in the UDCA group, PSL was added to 8 of 12 patients failing to achieve the normalization of serum transaminase levels with UDCA monotherapy. Cumulative incidence of the normalization of serum transaminase levels was 64% in the UDCA group, 95% in the combination group, and 94% in the PSL group (log-rank test, P = 0.0001). UDCA group required longest periods until the normalization of serum transaminase levels. Eleven patients, who achieved persistent normalization of serum transaminase levels with UDCA monotherapy, did not reach liver failure or develop hepatocellular carcinoma for 49.7 (range = 13.4-137.3) months. Meanwhile, during the taper of PSL, doses of PSL at the initial relapse were lower in patients treated with PSL and UDCA than in those treated with PSL monotherapy, and initial relapse occurred earlier in patients treated with PSL monotherapy. Conclusions: UDCA monotherapy is effective for some Japanese AIH patients; however, UDCA monotherapy for patients with either high-grade inflammatory activity or poor residual capacity of liver function is not recommended because they may reach liver failure before achievement of remission. Meanwhile, additional use of UDCA during the taper of corticosteroids may be effective for the prevention of early relapse.

AB - Purpose: This study aimed to investigate the efficacy of ursodeoxycholic acid (UDCA) for Japanese patients with autoimmune hepatitis (AIH). Methods: One hundred forty-seven patients were investigated. Results: As initial treatment, 25 patients received UDCA (300-600 mg/day) monotherapy (UDCA group), 40 received a combination of prednisolone (PSL) (≥20 mg/day) and UDCA (combination group), 68 received PSL monotherapy (PSL group), and 14 received other treatments. During the follow-up, in the UDCA group, PSL was added to 8 of 12 patients failing to achieve the normalization of serum transaminase levels with UDCA monotherapy. Cumulative incidence of the normalization of serum transaminase levels was 64% in the UDCA group, 95% in the combination group, and 94% in the PSL group (log-rank test, P = 0.0001). UDCA group required longest periods until the normalization of serum transaminase levels. Eleven patients, who achieved persistent normalization of serum transaminase levels with UDCA monotherapy, did not reach liver failure or develop hepatocellular carcinoma for 49.7 (range = 13.4-137.3) months. Meanwhile, during the taper of PSL, doses of PSL at the initial relapse were lower in patients treated with PSL and UDCA than in those treated with PSL monotherapy, and initial relapse occurred earlier in patients treated with PSL monotherapy. Conclusions: UDCA monotherapy is effective for some Japanese AIH patients; however, UDCA monotherapy for patients with either high-grade inflammatory activity or poor residual capacity of liver function is not recommended because they may reach liver failure before achievement of remission. Meanwhile, additional use of UDCA during the taper of corticosteroids may be effective for the prevention of early relapse.

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