Autoimmune hepatitis in patients aged 70 years or older: Disease characteristics, treatment response and outcome

Abstract

Autoimmune hepatitis (AIH) affects both sexes and all age groups. However, very few studies have focused specifically on the characteristics and outcome of AIH in patients aged 70y or older. 25/234 patients with well-established AIH and disease onset at ≥70-y (median: 73-y) were analysed and compared to the rest patients (median: 47y). Treatment response was assessed in all patients from both groups who were eligible for treatment (n=202). Disease presentation was mainly insidious in both groups (19/25, 76% vs. 134/209, 64.1%; P=.313). At diagnosis, older patients had lower alaninoaminotrasferase (101[433] vs. 199[441] IU/L, P<.05) but were more frequently cirrhotic (12/25, 48% vs. 57/209, 27.3%; P=.03). Importantly, similar rates of on-treatment response (16/18, 89% vs. 154/184, 84%; P=.565), corticosteroid withdrawal (10/16, 62.5% vs. 113/154, 73.4%; P=.355) and complete withdrawal of immunosuppression (1/16, 6.3% vs. 40/154, 26%; P=.122) were achieved in both groups. Treatment-related adverse events were evenly observed between groups (6/18, 33% vs. 54/184, 29%; P=.724). In treated patients, the age ≥70y was only associated with the overall mortality (HR 8.3 [95% CI: 2.1-36.4], P=.003), but not with the liver-related mortality (HR 3.4 [95% CI: 0.4-30.0], P=.268). AIH should be seriously considered in patients ≥70y with unexplained impaired liver function tests as the disease is not infrequent in this group and seems to bear an increased risk for advanced disease stage at diagnosis. However, if immunosuppression is started promptly, it seems as safe and effective as in younger patients.