Clinical and biochemical responses of monotherapy and combined therapy in patients with a diagnosis of autoimmune hepatitis

In this study, it was aimed to compare the clinical and biochemical responses of monotherapy and combined therapies given in patients diagnosed with autoimmüne hepatitis, and the superiority of both treatment protocols. In our study, the data of all patients over the age of 18 with a diagnosis of Autoimmüne Hepatitis who applied to the Gastroenterology Outpatient Clinic of Fırat University Hospital between December 2010 and December 2020 were retrospectively reviewed and a total of 140 patients were included in our study. When classifying OİH in patients, if ANA or ASMA is positive type 1 OİH, if anti-LKM-1 or LC-1 is positive type 2 OİH, AMA positivity and patients with histologically and clinically OID characteristics are classified as overlap syndrome. Pre-treatment and post-treatment clinical conditions, biochemical and pathological data of OİH patients were evaluated. Medical monotherapy (prednol or budesonide use) and combined therapies (budesonide and azathiopurine/prednol and azathiopurine use, secondly, corticosteroid, azathiopurine and ursodeoxycholic acid (UDCA) combined therapy) were taken as basis. Biochemical and clinical response rates, if there has been a change in treatment, it is aimed to reveal the cause and data on current health conditions. Treatment response evaluation in patients was performed after at least 2 years of biochemical and clinical follow-up. In our study, %50.7 (n=71) of our patients received monotherapy, % 49.3 (n=69) received combined therapy, and %47.9 (n=34) of those who received monotherapy received biochemical remission and combined therapy. Biochemical remission was achieved in 47.8% (n=33). 62.5% (n=20) of the patients who received monotherapy and had remission, and 47.1% (n=16) of those who received combined therapy were followed up without medication. At the same time, clinical remission was observed in %47.9 (n=34) of the patients who received monotherapy, and clinical remission was observed in 47.8% (n=33) of the patients who received combined therapy. Clinical and biochemical response rates were similar in both patient groups simultaneously.There was no statistically significant difference between the selected combined or monotherapy treatment protocols and biochemical and clinical improvement in the patients participating in our study. Again, a significant decrease was observed in all biochemical parameters of the patients included in our study with treatment, only a significant increase was observed in the albumin value. In our study, significant negativity was observed in ANA positivity after treatment, and in ASMA positivity, significant negativity was observed after treatment. Again, Anti LKM-1's of all patients who participated in our study who were positive for Anti LKM-1 became negative. In addition, % 96,4 (n=135) of 140 patients participating in our study had liver biopsy at the time of diagnosis, and a control liver biopsy was performed in %7,8 (n=11) of these patients after monotherapy or combined therapy. As a result of the control liver biopsy, a decrease in hepatocyte damage and a decrease in histological activity index was detected in %63,6 (n=7) of the patients. In conclusion, in our study, the efficacy of monotherapy and combined therapy given in patients with OİH was found to be similar to the literature in terms of treatment side effects and treatment intolerance, and it was observed that the progression of the disease was prevented by early diagnosis and early initiation of treatment.