Predictive factors of poor response to therapy in Autoimmune Hepatitis

Aim To evaluate “ex ante” the predictive factors of incomplete/absent response to the standard therapy in a well characterized series of Autoimmune Hepatitis (AIH) patients from Italy. Methods Of 282 AIH patients screened from our database 166 (59%) had a sustained response and 116 (41%) had an incomplete/absent response to the therapy; all patients were analyzed for the clinical, serological and histological parameters at diagnosis. Results The patients with incomplete/absent response were characterized by significantly younger age (30 aa vs 42 aa p = 0.001) and a significantly higher frequency of cirrhosis at diagnosis than patients who had a complete response to therapy (26% vs 3% p < 0.0001); furthermore, patients with incomplete/absent response were distinguished from those with a complete response for significantly lower serum levels of both AST (7.9 × upper normal limit [unl] vs 13 × unl p < 0.005) and ALT (10.9 × unl vs 18 × unl p = 0.002) at diagnosis, and by an increase in IgG serum levels (1.43 × unl vs 1.27 × unl p = 0.009). After stepwise logistic regression, cirrhosis at diagnosis (p = 0.003, OR 0.12, 95% CI 0.03–0.49) and younger age (p = 0.001, OR 1.03, 95% CI 1.01–1.05) represent two independent variables of incomplete/absent response. Conclusions Younger age and cirrhosis are predictive of lack of response to the standard therapy in AIH patients.