Copyright
©The Author(s) 2019.
World J Gastroenterol. Jun 14, 2019; 25(22): 2809-2818
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2809
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2809
Table 1 Risk of bias assessment in the included studies according to Risk Of Bias In Non-randomised Studies of Interventions scale
Biasdomains | Schram et al[6], 2001 | Granito et al[21], 2005 | Al-Chalabi et al[23], 2006 | Czaja et al[9], 2006 | Zhang et al[22], 2012 | Zachou et al[20], 2016 | Morii et al[24], 2017 |
Confounding | Moderate | Serious | Moderate | Moderate | Serious | Moderate | Moderate |
Selection of participants into study | Serious | Low | Low | Moderate | Moderate | Serious | Moderate |
Classification of interventions | Serious | Moderate | Moderate | Moderate | Serious | Moderate | Moderate |
Deviation from intended interventions | No information | Low | No information | No information | No information | Low | Moderate |
Missing data | Moderate | Moderate | Moderate | Serious | Serious | Serious | Serious |
Measurement of outcomes | Low | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate |
Selection of the reported results | Moderate | Moderate | Moderate | Moderate | Moderate | Serious | Moderate |
Overall | Serious | Serious | Moderate | Serious | Serious | Serious | Serious |
Table 2 Characteristics of included studies
Author(year) | Methods | No. of patients (F:M) | Diagnostic criteria | Country | Interventions | Median FU | Outcomes | Side effects |
Elderly:Youn-ger | ||||||||
Schramm et al[6], 2001 | Comparative Cohort Study | 40 (32:8) | IAIHG (1999) | Germany | -P alone | 4-164 mo | CR, relapse, all causes and liver-related death | GI symptoms, cholestasis, skin rush (AZA). VZ infection, pulmonary TB reactivation |
-P + AZA | (40 mo in elderly group) | |||||||
20 (≥ 65 yr, 50%):20 | -No treatment | |||||||
Granito et al[21], 2005 | Comparative Cohort Study | 76 (64:12) | IAIHG (1999) | Italy | -M alone | 1-16 yr (5 yr) in the elderly | CR, relapse, death | None in elderly group |
20 (≥ 65 yr, 26%):56 | -M + AZA | |||||||
-No treatment | ||||||||
Al-Chalabi et al[23], 2006 | Comparative Cohort Study | 164 (128:36) | IAIHG (1999) | UK | -P alone | 1-28 yr (9 yr) | CR, PR, TF, relapse, deaths/OLT | Cushingoid faces, osteoporosis, T2DM, hypertension, psychoses. Cytopenia (AZA) |
-P + AZA | ||||||||
43 (≥ 60 yr, 26%):121 | -(P + Cyclo | |||||||
and P + D-P in young only) | ||||||||
Czaja et al[9], 2006 | Comparative Cohort Study | 205 (175:30) | IAIHG (1999) | USA | -Pp alone | (77 mo) | Remission, SR, TF, relapse, death or OLT | Not reported |
-Pp + AZA | ||||||||
47 (≥ 60 yr, 23%):158 | -P + AZA | |||||||
-No treatment | ||||||||
Zhang et al[22], 2012 | Comparative Cohort Study | 75 (71:4) | IAIHG (1999) | China | -P alone | 6 mo-8 yr | Remission, SR, TF, relapse, death | Not reported |
36 (≥ 60 yr, 48%):39 | ||||||||
+ IAIHG (2008) | ||||||||
Zachou et al[20], 2016 | Comparative Cohort Study | 158 (114:44) | IAIHG (2008) | Greece | -P + MMF | 3-168 mo (72) in MMF group | CR, PR, TF, relapse, liver-related death, progression during FU, OLT | Sepsis, airway infections, VZ, mild GI symptoms, cytopenia (MMF) |
45 (> 60 yr, 28%):113 | -P alone | |||||||
-P + AZA | ||||||||
Morii et al[24], 2017 | Comparative Cohort Study | 71 (56:15) | IAIHG (1999) | Japan | -Pp alone | 2-69 mo (31 mo) | Remission, relapses | Not reported |
28 (≥ 70 yr, 39%):43 | -UDCA |
Table 3 Treatment regimens
Author (year) | Treatments |
Schramm et al[6], 2001 | P 1 mg/kg/die |
P 1 mg/kg/die + AZA 1-1.5 mg/kg/die | |
No treatment | |
Granito et al[21], 2005 | M 1 mg/kg/die |
M 30 mg/die + AZA 50 mg/die | |
No treatment | |
Al-Chalabi et al[23], 2006 | P 20-40 mg/die |
P 20-40 mg/die + AZA (1 mg/kg/die) | |
P 20-40 mg/die + Cyclo (only in the younger group) | |
P 20-40 mg/die + D-P (only in the younger group) | |
Czaja et al[9], 2006 | Pp (doses not specified) |
Pp + AZA (doses not specified) | |
Investigational therapies (drugs not specified) | |
No Treatment | |
Zhang et al[22], 2012 | P (doses not specified) |
P + AZA (doses not specified) | |
No treatment | |
Zachou et al[20], 2016 | P 0,5-1 mg/kg/die + MMF 1.5-2g/die |
P 0,5-1 mg/kg/die | |
P 0.5-1 mg/kg/die + AZA 1.5-2 mg/kg/die | |
Morii et al[24], 2017 | Pp 30-40 mg/die |
UDCA (dose not specified) |
Table 4 Outcome definitions
Author (year) | Remission | Treatment failure | Relapse |
Schramm et al[6], 2001 | IAIHG revised criteria (1999) | - | IAIHG revised criteria (1999) |
Granito et al[21], 2005 | IAIHG revised criteria (1999) | - | IAIHG revised criteria (1999) |
Al-Chalabi et al[23], 2006 | IAIHG revised criteria (1999) | IAIHG original criteria (1993) | IAIHG revised criteria (1999) |
PR: IAIHG original criteria (1993) | |||
Czaja et al[9], 2006 | Symptoms: Absent | Worsening of clinical, laboratory and/or histological alterations despite compliance to therapy | Symptom recurrence and increased serum AST level (> three-fold the ULN) after drug withdrawal |
AST level: Normal or near normal (< two-fold the UNL) | |||
Histology: Minimal/no inflammation | |||
SR: | |||
Symptoms: Absent | |||
Serum AST levels: Normal or below the relapse threshold | |||
after drug withdrawal | |||
Zhang et al[22], 2012 | Symptoms: Absent | Worsening of clinical, laboratory and/or histological alterations despite compliance to therapy | Symptom recurrence and increased serum AST level (> three-fold the ULN) after drug withdrawal |
AST levels: Normal or near normal (< two-fold the UNL) | |||
Histology: Minimal or no inflammation. | |||
SR: | |||
Symptoms: Absent | |||
AST levels: Normal or below the relapse threshold after drug withdrawal | |||
Zachou et al[20], 2016 | CR: | Persistently elevated AST and ALT (> three-fold the UNL) and/or increased IgG despite intensive immunosuppression and compliance to therapy | Rise in AST and ALT levels (> three-fold the UNL) and/or increased IgG (> 2000 mg/dL) during therapy with or without symptom recurrence after initial CR |
Symptoms: Improved | |||
AST, ALT, IgG levels: normal | |||
Histology: Minimal/no inflammation | |||
PR: | |||
ALT or AST levels: Decreased (< two-fold ULN) without achieving complete normalization and inability to withdraw or taper prednisolone | |||
Morii et al[24], 2017 | Normal serum ALT and IgG levels | - | Re-exacerbation not explicitly defined |
- Citation: Durazzo M, Lupi G, Scandella M, Ferro A, Gruden G. Autoimmune hepatitis treatment in the elderly: A systematic review. World J Gastroenterol 2019; 25(22): 2809-2818
- URL: https://www.wjgnet.com/1007-9327/full/v25/i22/2809.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i22.2809