ArticleDigestive diseases and sciences2025
Efficacy, Safety and Long-Term Clinical Outcomes of Low-Dose Versus High-Dose Prednisolone Induction in Autoimmune Hepatitis: A Propensity Score-Matched Analysis.
Article in Digestive diseases and sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsMultiple corticosteroid dosing regimens are used in managing autoimmune hepatitis (AIH). We aimed to compare the efficacy of a low- versus high-dose prednisolone induction regimen in achieving a biochemical response in AIH.
methodsIn this retrospective review of a prospectively maintained database, treatment-naive AIH patients treated with prednisolone were categorized into high-dose (> 20 mg/day) and low-dose (≤ 20 mg/day) groups. The primary outcome was the biochemical response, defined as normalization of serum transaminases within 6 months of treatment. Propensity score matching was applied in a 1:1 ratio. Kaplan-Meier survival analysis was used to compare index or further decompensation, and mortality.
resultsOf 121 patients, 47 received low-dose and 74 high-dose prednisolone. After matching 45 patients remained in each group: 92.2% received concomitant azathioprine or mycophenolate mofetil, whereas the remaining received prednisolone monotherapy. Six-month biochemical response rates were similar between low- and high-dose groups (62.2% vs. 60.0%; p = 0.829). Patients with cirrhosis had lower response rates than those without cirrhosis, with no difference between low- and high-dose prednisolone in either group. Index decompensation among compensated patients (HR, 1.17; 95% CI 0.26-5.37; p = 0.838), further decompensation among previously decompensated patients (HR, 1.41; 95% CI 0.54-3.71; p = 0.480) were also comparable in the 2 groups. Mortality rates were also similar. There was a trend toward fewer steroid-related side effects in the low-dose group (27.7% vs. 43.2%; p = 0.084).
conclusionLow-dose (≤ 20 mg/day) prednisolone induction results in similar biochemical response and clinical outcomes compared to a high-dose (> 20 mg/day) regimen in patients with AIH.
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