Cirrhosis and Autoimmune Liver Disease

AbstractPurpose of ReviewAutoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) constitute the most frequently observed forms of autoimmune liver diseases. Each of these autoimmune liver diseases might present with cirrhosis at diagnosis, and a significant proportion of patients develop cirrhosis during follow-up. This manuscript provides a review that addresses how to monitor and manage patients with cirrhosis secondary to autoimmune liver diseases.Recent FindingsFor patients with PBC, the farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), is the first approved drug since ursodeoxycholic acid (UDCA) and is licensed for non-responders to or those intolerant of UDCA. Bezafibrate has been shown to be effective in non-responders to UDCA, but is not licensed for this clinical indication at present. For patients with AIH, rituximab, a monoclonal antibody against the protein CD20 is a potential option for patients with suboptimal response to corticosteroids. New treatment options are currently being investigated for AIH and PSC that include the anti-B cell-activating factor receptor monoclonal antibodies, nor-UDCA, amongst others, but the efficacy in patients with cirrhosis has not been fully established.SummaryCirrhosis is present in 30 –50% of patients at the time of diagnosis of AIH, in 20% of patients with PBC, and in 35% of patients with PSC. Therefore, cirrhosis constitutes one of the main complications of autoimmune...

Source: Current Hepatitis Reports - January 28, 2019 Category: Infectious Diseases Source Type: research