Autoimmune hepatitis in southern Israel: A 15-year multicenter study

• Published in: Journal of digestive diseases 2013-11, Vol.14 (11), p.611-618
• Main Authors: Delgado, Jorge-Shmuel, Vodonos, Alina, Malnick, Stephen, Kriger, Ofra, Wilkof-Segev, Renana, Delgado, Bertha, Novack, Victor, Rosenthal, Alexander, Menachem, Yoram, Melzer, Ehud, Fich, Alexander
• Format: Article
• Language: English
• Subjects: Adult; autoimmune hepatitis; Azathioprine - therapeutic use; Biopsy; Budesonide - therapeutic use; Clinical outcomes; Drug Therapy, Combination; epidemiology; Female; Glucocorticoids - therapeutic use; Hepatitis, Autoimmune - diagnosis; Hepatitis, Autoimmune - drug therapy; Hepatitis, Autoimmune - epidemiology; Hepatitis, Autoimmune - pathology; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Israel; Israel - epidemiology; Liver - pathology; Liver cirrhosis; Male; Medical prognosis; Middle Aged; outcome; Prednisone - therapeutic use; Prevalence; Prognosis; Retrospective Studies; therapy; Treatment Outcome
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.12085

Objective In this study we aimed to assess the incidence, prevalence and clinical outcomes of patients with autoimmune hepatitis (AIH) in southern Israel. Methods Case‐finding methods and population‐based administrative data were used to evaluate the epidemiology and prognostic factors of AIH from 1995 to 2010. Results During the study period, the average annual prevalence and incidence of AIH in southern Israel were 11.0/100 000 and 0.67/100 000, respectively. We identified 100 AIH cases with a mean age of 47.9 years, including 95 women and five men. Type 1 AIH was found in 77 cases, and liver fibrosis and cirrhosis were found in 73.4% and 22.3% of all patients who underwent liver biopsy. In all, 98 patients were treated with a combination of steroids and azathioprine or steroids alone (prednisone and azathioprine in 71, budesonide and azathioprine in 11, prednisone or budesonide alone in six and ten, respectively). Complete remission was recorded in 56 patients, whereas partial response or failure of treatment was noted in 42 patients. In multivariate analysis the independent predictors of remission were the degree of liver fibrosis (mild vs bridging fibrosis (F3) and cirrhosis [F4]) (P = 0.003) and level of albumin (P = 0.031). The estimated 1‐year and 10‐year survival for AIH were 96.5% and 89.7%, respectively. Conclusions The prevalence of AIH in Israel is quite similar to that of other European Caucasian populations, with a relatively long‐term good prognosis, despite a low rate of response to immunosuppressive therapy.