Gerçek Yaşamda Karaciğer ve İnflamatuar Barsak Hastalıkları Sempozyumu

SS38 (P2)
Can Budesonide be a new standard of remission maintenance therapy for
non-cirrhotic patients with AIH?
Fehmi Ates 1 , Serkan Yaras 1 , Osman Ozdogan 1 , Enver Ucbilek 1 , Engin Altintas 1 , Orhan Sezgin 1
1
Mersin Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı
BACKGROUND & AIMS: The initial treatment of choice for autoimmune hepatitis (AIH) is prednisone
alone or with azathioprine. A significant number of patients with AIH develop steroid-specific side effects
or require doses of steroids that are unacceptable for long-term treatment. We investigated the efficacy
and safety of budesonide as an alternative steroid maintenance therapy for patients which were previously
treated with prednisolone remission induction therapy.
METHODS: We performed a retrospective analysis of data from 36 patients (30 female) with non-cirrhotic
AIH who were treated initially with prednisolone but then switched to budesonide, conducted at two
centers in Turkey from 2009 through November 2017. Patients were evaluated after 6 months, 12 months,
24 months, 36 months, and at the last follow-up evaluation; response to treatment with budesonide was
assessed based on normal serum levels of aminotransferases and IgG (biochemical response).
RESULTS: Twenty patients were switched to budesonide therapy because of prednisolone-induced side
effects and 16 patients were switched because of prednisolone dependency. Completely, a biochemical
response was detected in 58% of patients after 6 months of budesonide treatment, in 75% after 12 months,
and in 72% after 24 months. At the last follow-up evaluation (mean time, 60 mo) 12 patients (33%) were still
receiving budesonide treatment. Six patients (17%) had stopped budesonide therapy because of insufficient
response to budesonide or its side effects. Nine patients with osteopenia at the beginning of budesonide
treatment were followed up and evaluated by dual-energy X-ray absorptiometry. After a median of 24
months of budesonide treatment, bone mineral density had improved in 5 patients, remained stable in 4
patients.
CONCLUSIONS: Oral budesonide, in combination with azathioprine, can effectively maintain remission
in patients with non-cirrhotic AIH, with a low rate of steroid-specific side effects. The combination of
budesonide with azathioprine may therefore become a new standard of remission maintenance therapy for
non-cirrhotic patients with AIH.
66