title: Liver fibrosis may reduce the efficacy of budesonide in the treatment of autoimmune hepatitis and overlap syndrome.
abstract: OBJECTIVE
  The aim of the present study was to assess the efficacy and tolerability of budesonide as an alternative first line treatment option for autoimmune hepatitis (AIH) and the overlap syndrome.
  
  
  METHODS
  A total of 18 AIH or overlap syndrome patients were evaluated. Outcomes of treatment by the end of the study were defined as treatment failure, partial response, complete response and remission.
  
  
  RESULTS
  Complete response and remission were achieved in 61.1% (11/18) of patients, while 38.9% (7/18) of patients were considered treatment failures. Liver fibrosis was observed in 55.5% of patients' biopsies. More patients with liver fibrosis failed to respond to treatment compared to patients without fibrosis, a difference bordering on statistical significance (60% vs. 12.5%; p=0.066). Although statistically insignificant, the presence of at least one side effect was observed more frequently in patients with fibrosis compared to those without fibrosis (80% vs. 37.5%; p=0.145). Overall, side effects occurred significantly more commonly in non-responders than responders (100% vs. 36%; p=0.013).
  
  
  CONCLUSIONS
  Budesonide is an effective treatment option for the management of AIH, with a low incidence of side effects in patients without findings of advanced liver disease. The presence of liver fibrosis may increase the likelihood of treatment failure as well as the risk of developing side effects. Our study findings suggest that budesonide may be effective in a select group of AIH patients. Further studies are needed to determine its exact place for the treatment of AIH and overlap syndrome.
authors: Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey. drcumi21@hotmail.com
authors: Cumali
authors: C
authors: Efe
authors: Ersan
authors: E
authors: Ozaslan
authors: Taylan
authors: T
authors: Kav
authors: Tugrul
authors: T
authors: Purnak
authors: Ali
authors: A
authors: Shorbagi
authors: Ozgür
authors: O
authors: Ozkayar
authors: Alexandra Heurgue
authors: AH
authors: Berlot
authors: Cenk
authors: C
authors: Sökmensuer
authors: Paolo
authors: P
authors: Muratori
mesh_terms: D000328:Adult; D000368:Aged; D019819:Budesonide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D019819:Budesonide