Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2019; 25(22): 2809-2818
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2809
Autoimmune hepatitis treatment in the elderly: A systematic review
Marilena Durazzo, Giulia Lupi, Michela Scandella, Arianna Ferro, Gabriella Gruden
Marilena Durazzo, Giulia Lupi, Michela Scandella, Arianna Ferro, Gabriella Gruden, Department of Medical Sciences, University of Turin, Turin 10126, Italy
Author contributions: Durazzo M designed the systematic review and critically revised the work; Lupi G, Scandella M and Ferro A performed the systematic research; Durazzo M, Lupi G, Ferro A, and Scandella M wrote the paper; Gruden G revised the text and the English.
Conflict-of-interest statement: The Authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marilena Durazzo, MD, PhD, Associate Professor, Department of Medical Sciences, University of Turin, C So AM Dogliotti 14, Turin 10126, Italy. marilena.durazzo@unito.it
Telephone: +39-11-633-5541 Fax: +39-11-633-5401
Received: March 14, 2019
Peer-review started: March 14, 2019
First decision: April 10, 2019
Revised: April 30, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 14, 2019
Abstract
BACKGROUND

Autoimmune hepatitis (AIH) is a rare chronic inflammatory liver disease with a high risk of progression to liver cirrhosis. The initial treatment for AIH usually includes a steroid, with or without azathioprine. AIH can present at any age; however, the most effective and safe induction treatment for AIH in the elderly remains unclear.

AIM

To systematically review available data on both effectiveness and safety of AIH treatments in elderly subjects.

METHODS

To identify studies on AIH induction treatment in elderly patients (≥ 60 years of age), an electronic research was performed (PubMed, EMBASE and Cochrane Library databases) until February 2019. Eligible studies were selected through screening of titles and abstracts, followed by full-text critical evaluation. After risk of bias assessment, data on study designs, interventions, and outcomes were extracted and reviewed.

RESULTS

Among the 1736 retrieved papers, 15 studies were selected. Out of them, eight studies were excluded because of a critical risk of bias. The remaining seven studies included 789 patients and out of them 239 subjects were elders. First-line treatment was a steroid either alone or in combination with azathioprine in most patients (87.6%) and only one study investigated the effect of combined steroid and mycophenolate mofetil therapy. Standard therapy was effective in inducing remission in the elderly. Moreover, treatment failure and relapses occurred less often in the elderly compared to younger people.

CONCLUSION

Treatment of AIH is challenging in elderly patients. This systematic review confirms the efficacy and safety of standard induction treatment for AIH in the elderly. Available evidence is insufficient to draw any conclusion on the effect of novel AIH treatments in elderly subjects.

Keywords: Autoimmune hepatitis, Elderly patients, Aged, Steroids, Azathioprine, Mycophenolate mofetil

Core tip: Autoimmune hepatitis (AIH) is a severe liver disease that affects patients worldwide. Conventional treatment with a steroid and azathioprine is the mainstay of treatment. Although elderly patients have a relatively high incidence of AIH, data on its treatment in the elderly are limited. We focused on this subgroup of patients and systematically reviewed studies testing both efficacy and safety of AIH treatments in old patients. Available data support the use of conventional treatment, while the effect of other drugs has only been tested in small case series.