Universität zu Köln

Schulze, Kornelius, Weismueller, Tobias J., Bubenheim, Michael, Huebener, Peter ORCID: 0000-0001-7558-7625, Zenouzi, Roman, Lenzen, Henrike, Rupp, Christian, Gotthardt, Daniel, de Leuw, Philipp, Teufel, Andreas, Zimmer, Vincent ORCID: 0000-0002-6298-4717, Reiter, Florian P., Rust, Christian, Tharun, Lars, Quaas, Alexander, Weidemann, Soern A., Lammert, Frank, Sarrazin, Christoph, Manns, Michael P., Lohse, Ansgar W. and Schramm, Christoph ORCID: 0000-0002-4264-1928 (2015). Criteria Used in Clinical Practice to Guide Immunosuppressive Treatment in Patients with Primary Sclerosing Cholangitis. PLoS One, 10 (10). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background & Aims Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC. Methods This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks. Results A simplified autoimmune hepatitis (AIH) score > 5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002). Conclusions This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score > 5 and a mHAI score > 3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schulze, Kornelius UNSPECIFIED UNSPECIFIED UNSPECIFIED Weismueller, Tobias J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bubenheim, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Huebener, Peter UNSPECIFIED orcid.org/0000-0001-7558-7625 UNSPECIFIED Zenouzi, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Lenzen, Henrike UNSPECIFIED UNSPECIFIED UNSPECIFIED Rupp, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Gotthardt, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED de Leuw, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Teufel, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Zimmer, Vincent UNSPECIFIED orcid.org/0000-0002-6298-4717 UNSPECIFIED Reiter, Florian P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rust, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Tharun, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Quaas, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Weidemann, Soern A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lammert, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Sarrazin, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Manns, Michael P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lohse, Ansgar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schramm, Christoph UNSPECIFIED orcid.org/0000-0002-4264-1928 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-389503
DOI:	10.1371/journal.pone.0140525
Journal or Publication Title:	PLoS One
Volume:	10
Number:	10
Date:	2015
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AUTOIMMUNE HEPATITIS; SCORING SYSTEM; DIAGNOSIS; MANAGEMENT; PATHOGENESIS; OVERLAP Multiple languages Multidisciplinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38950