Background & Aims: While avoidance of long-term corticosteroids is a common objective in the management of autoimmune hepatitis (AIH), prolonged immunosuppression is usually required to prevent disease progression. This study investigates the patient and provider factors associated with treatment patterns in U.S. patients with AIH. Approach & Results: A retrospective cohort of adults with incident and prevalent AIH was identified from Optum’s de-identified Clinformatics® Data Mart Database. All patients were followed for at least 2 years, with exposures assessed during the first year and treatment patterns during the second. Patient and provider factors associated with corticosteroid-sparing monotherapy and cumulative prednisone use were identified using multivariable logistic and linear regression, respectively. The cohort was 81.2% female, 66.3% White, 11.3% Black, 11.2% Hispanic and with median age 61 years. Among 2,203 patients with ≥1 AIH prescription fill, 83.1% received a single regimen for >6 months of the observation year, which included 52.2% azathioprine monotherapy, 16.9% azathioprine/prednisone and 13.3% prednisone monotherapy. Budesonide use was uncommon (2.1% combination, 1.9% monotherapy). Hispanic ethnicity (aOR 0.56; p=0.006), cirrhosis (aOR 0.73; p=0.019), osteoporosis (aOR 0.54; p=0.001) and top quintile of provider AIH experience (aOR 0.66; p=0.005) were independently associated with lower use of corticosteroid-sparing monotherapy. Cumulative prednisone use was greater with diabetes (+441 mg/year; p=0.004), osteoporosis (+749 mg/year; p<0.001) and highly experienced providers (+556 mg/year; p<0.001). Conclusions: Long-term prednisone therapy remains common, and unexpectedly higher among patients with comorbidities potentially aggravated by corticosteroids. The greater use of corticosteroid-based therapy with highly experienced providers may reflect more treatment-refractory disease.

中文翻译：

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美国成人自身免疫性肝炎维持治疗实践相关因素的真实世界证据


背景和目的：虽然避免长期使用皮质类固醇是治疗自身免疫性肝炎（AIH）的一个共同目标，但通常需要长期免疫抑制来防止疾病进展。本研究调查了与美国 AIH 患者治疗模式相关的患者和提供者因素。方法和结果：从 Optum 的去识别化 Clinformatics® 数据集市数据库中确定了一组患有偶发性和流行性 AIH 的成人回顾性队列。所有患者均接受至少 2 年的随访，第一年评估暴露情况，第二年评估治疗模式。分别使用多变量逻辑回归和线性回归确定与节省皮质类固醇单一疗法和累积泼尼松使用相关的患者和提供者因素。该队列中 81.2% 为女性，66.3% 为白人，11.3% 为黑人，11.2% 为西班牙裔，中位年龄 61 岁。在 2,203 名 AIH 处方量≥1 次的患者中，83.1% 的患者在观察年的 6 个月以上接受单一治疗方案，其中包括 52.2% 的硫唑嘌呤单药治疗、16.9% 的硫唑嘌呤/泼尼松治疗和 13.3% 的泼尼松单药治疗。布地奈德的使用并不常见（2.1% 联合治疗，1.9% 单药治疗）。西班牙裔种族（aOR 0.56；p=0.006）、肝硬化（aOR 0.73；p=0.019）、骨质疏松症（aOR 0.54；p=0.001）和前五分之一的提供者 AIH 经验（aOR 0.66；p=0.005）与较低的独立相关。使用节省皮质类固醇的单一疗法。糖尿病（+441 毫克/年；p=0.004）、骨质疏松症（+749 毫克/年；p<0.001）和经验丰富的医疗服务提供者（+556 毫克/年；p<0.001）的累积泼尼松使用量更高。 结论：长期泼尼松治疗仍然很常见，并且在皮质类固醇可能加重合并症的患者中，这种情况出乎意料地更高。经验丰富的提供者更多地使用基于皮质类固醇的治疗可能反映出更多的难治性疾病。