6533b852fe1ef96bd12ab8d0
RESEARCH PRODUCT
Budesonide induces remission more effectively than prednisone in a controlled trial of patients with autoimmune hepatitis.
Martti FärkkiläMichael P. MannsChristian P. StrassburgAnsgar W. LohseMatthias J. BahrWolfgang KreiselMarkus PrölsRolf HultcrantzYoav LurieChristian RustElimelech ZuckermanFerenc SzalayUlrich SpenglerRainer GüntherMarek Woynarowskisubject
BudesonideAdultMalemedicine.medical_specialtyCirrhosisAdolescentAzathioprineAutoimmune hepatitisChronic liver diseaseGastroenterology03 medical and health sciences0302 clinical medicineHLA-DR3 AntigenDouble-Blind MethodPrednisoneInternal medicineMedicineHumansProspective StudiesBudesonideChildAgedHepatitisIntention-to-treat analysisHepatologybusiness.industryGastroenterologyMiddle Agedmedicine.disease3. Good healthHepatitis AutoimmuneEndocrinology030220 oncology & carcinogenesisPrednisone030211 gastroenterology & hepatologyFemalebusinessmedicine.drugdescription
Autoimmune hepatitis (AIH) is a chronic liver disease associated with cirrhosis and liver failure. Corticosteroid therapy induces long-term remission but has many side effects. We compared the effects of budesonide (a steroid that is rapidly metabolized, with low systemic exposure) and prednisone, both in combination with azathioprine.We performed a 6-month, prospective, double-blind, randomized, active-controlled, multicenter, phase IIb trial of patients with AIH without evidence of cirrhosis who were given budesonide (3 mg, three times daily or twice daily) or prednisone (40 mg/d, tapered to 10 mg/d); patients also received azathioprine (1-2 mg/kg/d). Treatment was followed by a 6-month, open-label phase during which all patients received budesonide in addition to azathioprine. The primary end point was complete biochemical remission, defined as normal serum levels of aspartate aminotransferase and alanine aminotransferase, without predefined steroid-specific side effects, at 6 months.The primary end point was achieved in 47/100 patients given budesonide (47.0%) and in 19/103 patients given prednisone (18.4%) (P.001; 97.5% 1-side confidence interval [CI] = 16.2). At 6 months, complete biochemical remission occurred in 60% of the patients given budesonide versus 38.8% of those given prednisone (P = .001; CI: 7.7); 72.0% of those in the budesonide group did not develop steroid-specific side effects versus 46.6% in the prednisone group (P.001; CI = 12.3). Among 87 patients who were initially given prednisone and then received budesonide after 6 months, steroid-specific side effects decreased from 44.8% to 26.4% at month 12 (P.002).Oral budesonide, in combination with azathioprine, induces and maintains remission in patients with noncirrhotic AIH, with a low rate of steroid-specific side effects.
year | journal | country | edition | language |
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2010-04-07 | Gastroenterology |