Criteria Used in Clinical Practice to Guide Immunosuppressive Treatment in Patients with Primary Sclerosing Cholangitis: e0140525

Background & Aims Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since the...

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Bibliographic Details
Published in:PloS one 2015-10, Vol.10 (10)
Main Authors: Schulze, Kornelius, Weismueller, Tobias J, Bubenheim, Michael, Huebener, Peter, Zenouzi, Roman, Lenzen, Henrike, Rupp, Christian, Gotthardt, Daniel, Leuw, Philipp de, Teufel, Andreas
Format: Article
Language:English
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Summary:Background & Aims Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC. Methods This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks. Results A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.
ISSN:1932-6203
DOI:10.1371/journal.pone.0140525