Association of HLA-DR14 with the treatment response in Japanese patients with autoimmune hepatitis.
BACKGROUND
Influence of human lymphocyte antigen (HLA) on the therapeutic response in autoimmune hepatitis (AIH) is not known.


OBJECTIVE
To evaluate if HLA-DR types influence biological and histological responses to corticosteroids in patients with AIH.


METHODS
During 28 years from 1979 through 2007, 48 patients with definite diagnosis of AIH received long-term corticosteroid therapy (median 9 years [range: 5-28 years]) in a single Japanese center. They were followed for transaminase levels and received liver biopsy before and after the treatment.


RESULTS
DR4 was detected in 32 and DR14 in 11 patients; seven possessed both DR4 and DR14. DR4 was more frequent in AIH patients than in the general population (67% vs. 22%), while DR14 was comparably frequent between them (23% vs. 17%). Overall, biochemical response was achieved in 43 (90%) of the 48 patients. The sustained biochemical response to a maintenance prednisolone dose < 10 mg was gained more frequently in the patients with than without DR14 (10/11 [91%] vs. 10/37 [27%], P < 0.001). Marked histological improvement with a decrease in histology activity index (HAI) score by > 2 points was achieved in 31 of the 32 (97%) biochemical responders. Histological aggravation with an increase in HAI score occurred in 4 of the 16 (25%) patients without biochemical response (non-responders and relapsers combined), but in none of the 32 responders.


CONCLUSIONS
Long-term immunosuppressive treatment can improve the outcome of Japanese patients with AIH, and DR14 is associated with excellent biochemical response.
Suzuki
Yoshiyuki
Y
Department of Hepatology, Toranomon Hospital, Takatsu-ku, Kawasaki City, Japan. suzunari@interlink.or.jp
Ikeda
Kenji
K
Hirakawa
Miharu
M
Kawamura
Yusuke
Y
Yatsuji
Hiromi
H
Sezaki
Hitomi
H
Hosaka
Tetsuya
T
Akuta
Norio
N
Kobayashi
Masahiro
M
Suzuki
Fumitaka
F
Saitoh
Satoshi
S
Arase
Yasuji
Y
Kobayashi
Mariko
M
Miyakawa
Yuzo
Y
Kumada
Hiromitsu
H
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006684:HLA-DR Antigens / Q000187:drug effects / Q000276:immunology*; D059810:HLA-DR Serological Subtypes; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011336:Probability; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
D001323:Autoantibodies; D015415:Biomarkers; D006684:HLA-DR Antigens; D059810:HLA-DR Serological Subtypes; C052238:HLA-DR14; D007166:Immunosuppressive Agents; D011239:Prednisolone