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
Processing time: 93 Days and 19.6 Hours
ARTICLE HIGHLIGHTS
Research background

Autoimmune hepatitis (AIH) is a rare chronic inflammatory disease potentially leading to severe liver damage. Untreated AIH has a poor prognosis, but the response rate to fist-line immunosuppressive therapy with a steroid either alone or in combination with azathioprine is very high. Moreover, novel immunosuppressive drugs have been recently proposed for AIH treatment in adult patients.

Research motivation

AIH also affects elderly patients; however, only a few intervention studies were performed in old patients. Whether standard treatment with a steroid, with or without azathioprine, is the best therapeutic strategy in the elderly is unclear.

Research objectives

To assess current evidence on AIH therapy in the elderly, we systematically reviewed studies testing both efficacy and safety of first-line pharmacotherapy for AIH in the elderly.

Research methods

Electronic databases (PubMed National Library of Medicine, EMBASE, Cochrane Library) were searched to identify studies on AIH treatment in the elderly (≥ 60 years of age). Following study selection, eligible studies underwent risk of bias assessment. Data on study characteristics, interventions, and outcomes were then extracted. The work was carried out according to the PRISMA Guidelines.

Research results

Seven cohort studies, enrolling 789 AIH patients, were included. Elderly patients were 239 (30.3%). Six studies reported data on the efficacy of convention treatment with a steroid (alone or in combination with azathioprine) in elderly and younger AIH patients. Only one study compared the effect of another drug (mycophenolate mofetil). Overall remission rate was high and comparable in elderly and younger patients. Notably, both failure of treatment and relapses occurred less frequently in elderly patients. Adverse effects were rare in both groups. The quality of the evidence was low and the heterogeneity elevated among included studies.

Research conclusions

Our results confirm the efficacy and safety of standard treatment with a steroid and azathioprine for AIH in the elderly. Data on other type of treatments were insufficient to draw final conclusion.

Research perspectives

Available data on pharmacotherapy for AIH in the elderly are very limited and the effect of novel drugs poorly known. Moreover, results were obtained in small non-randomised studies that were heterogeneous for patient clinical characteristics, outcome assessment, and follow-up duration. Therefore, well-designed randomized clinical trials, comparing efficacy and safety of currently available first-line drugs for AIH in the elders, are needed. In addition, further studies are required to establish effectiveness of second-line treatments for elderly patients resistant to conventional therapy.