18 results on '"de Boer, Ynto S."'
Search Results
2. An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis
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Snijders, Romée J.A.L.M., Stoelinga, Anna E.C., Gevers, Tom J.G., Pape, Simon, Biewenga, Maaike, Tushuizen, Maarten E., Verdonk, Robert C., de Jonge, Hendrik J.M., Vrolijk, Jan Maarten, Bakker, Sjoerd F., Vanwolleghem, Thomas, de Boer, Ynto S., Baven Pronk, Martine A.M.C., Beuers, Ulrich, van der Meer, Adriaan J., Gerven, Nicole M.F. van, Sijtsma, Marijn G.M., van Eijck, Brechje C., van IJzendoorn, Manon C., van Herwaarden, Margot, van den Brand, Floris F., Korkmaz, Kerem Sebib, van den Berg, Aad P., Guichelaar, Maureen M.J., Levens, Amar D., van Hoek, Bart, and Drenth, Joost P.H.
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- 2024
- Full Text
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3. Incidence and predictors of hepatocellular carcinoma in patients with autoimmune hepatitis
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van Gerven, N., van Erpecum, K., Ouden, J den, Brouwer, J., Vrolijk, J., Gevers, T.J., Drenth, J., Guichelaar, M., Bouma, G., Schreuder, T.C.M.A., van der Wouden, E.J., Baak, L.C., Stadhouders, P., Klemt-Kropp, M., Verhagen, M., Bhalla, A., Kuijvenhoven, J., Almasio, P., Alvarez, F., Andrade, R., Arikan, C., Assis, D., Bardou-Jacquet, E., Biewenga, M., Cancado, E., Cazzagon, N., Chazouillères, O., Colloredo, G., Cuarterolo, M., Dalekos, G., Debray, D., Robles-Díaz, M., Dyson, J., Efe, C., Engel, B., Ferri, S., Fontana, R., Gatselis, N., Gerussi, A., Halilbasic, E., Halliday, N., Heneghan, M., Hirschfield, G., van Hoek, B., Hørby Jørgensen, M., Indolfini, G., Iorio, R., Invernizzi, P., Jeong, S., Jones, D., Kelly, D., Kerkar, N., Lacaille, F., Lammert, C., Leggett, B., Lenzi, M., Levy, C., Liberal, R., Lleo, A., Lohse, A., Lopez, S. Ines, de Martin, E., McLin, V., Mieli-Vergani, G., Milkiewicz, P., Mohan, N., Muratori, L., Nebbia, G., van Nieuwkerk, C., Oo, Y., Ortega, A., Páres, A., Pop, T., Pratt, D., Purnak, T., Ranucci, G., Rushbrook, S., Schramm, C., Stättermayer, A., Swain, M., Tanaka, A., Taubert, R., Terrabuio, D., Terziroli, B., Trauner, M., Valentino, P., van den Brand, F., Vergani, D., Villamil, A., Wahlin, S., Ytting, H., Zachou, K., Zeniya, M., Colapietro, Francesca, Maisonneuve, Patrick, Lytvyak, Ellina, Beuers, Ulrich, Verdonk, Robert C., van der Meer, Adriaan J., van Hoek, Bart, Kuiken, Sjoerd D., Brouwer, Johannes T., Muratori, Paolo, Aghemo, Alessio, Carella, Francesco, van den Berg, Ad P., Zachou, Kalliopi, Dalekos, George N., Di Zeo-Sánchez, Daniel E., Robles, Mercedes, Andrade, Raul J., Montano-Loza, Aldo J., van den Brand, Floris F., Slooter, Charlotte D., Macedo, Guilherme, Liberal, Rodrigo, de Boer, Ynto S., and Lleo, Ana
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- 2024
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4. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report
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Andrade, Raúl J., Aithal, Guruprasad P., de Boer, Ynto S., Liberal, Rodrigo, Gerbes, Alexander, Regev, Arie, Terziroli Beretta-Piccoli, Benedetta, Schramm, Christoph, Kleiner, David E., De Martin, Eleonora, Kullak-Ublick, Gerd A., Stirnimann, Guido, Devarbhavi, Harshad, Vierling, John M., Manns, Michael P., Sebode, Marcial, Londoño, Maria Carlota, Avigan, Mark, Robles-Diaz, Mercedes, García-Cortes, Miren, Atallah, Edmond, Heneghan, Michael, Chalasani, Naga, Trivedi, Palak J., Hayashi, Paul H., Taubert, Richard, Fontana, Robert J., Weber, Sabine, Oo, Ye Htun, Zen, Yoh, Licata, Anna, Lucena, M Isabel, Mieli-Vergani, Giorgina, Vergani, Diego, and Björnsson, Einar S.
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- 2023
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5. Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial): study protocol for a randomised controlled trial
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Snijders, Romée J. A. L. M., Stoelinga, Anna E. C., Gevers, Tom J. G., Pape, Simon, Biewenga, Maaike, Verdonk, Robert C., de Jonge, Hendrik J. M., Vrolijk, Jan Maarten, Bakker, Sjoerd F., Vanwolleghem, Thomas, de Boer, Ynto S., Pronk, Martine A. M. C. Baven, Beuers, Ulrich H. W., van der Meer, Adriaan J., van Gerven, Nicole M. F., Sijtsma, Marijn G. M., Verwer, Bart J., Gisbertz, Ingrid A. M., Bartelink, Maartje, van den Brand, Floris F., Sebib Korkmaz, Kerem, van den Berg, Aad P., Guichelaar, Maureen M. J., Soufidi, Khalida, Levens, Amar D., van Hoek, Bart, and Drenth, Joost P. H.
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- 2022
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6. Reply: Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome—First report of the IAIHG retrospective registry
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Slooter, Charlotte D., primary, van den Brand, Floris F., additional, Lleo, Ana, additional, Liberal, Rodrigo, additional, and de Boer, Ynto S., additional
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- 2023
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7. Incidence and predictors of hepatocellular carcinoma in patients with autoimmune hepatitis
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Colapietro, Francesca, primary, Maisonneuve, Patrick, additional, Lytvyak, Ellina, additional, Beuers, Ulrich, additional, Verdonk, Robert C., additional, van der Meer, Adriaan J., additional, van Hoek, Bart, additional, Kuiken, Sjoerd D., additional, Brouwer, Johannes T., additional, Muratori, Paolo, additional, Aghemo, Alessio, additional, Carella, Francesco, additional, van den Berg, Ad P., additional, Zachou, Kalliopi, additional, Dalekos, George N., additional, Di Zeo-Sánchez, Daniel E., additional, Robles, Mercedes, additional, Andrade, Raul J., additional, Montano-Loza, Aldo J., additional, van den Brand, Floris F., additional, Slooter, Charlotte D., additional, Macedo, Guilherme, additional, Liberal, Rodrigo, additional, de Boer, Ynto S., additional, Lleo, Ana, additional, van Gerven, N., additional, van Erpecum, K., additional, Ouden, J den, additional, Brouwer, J., additional, Vrolijk, J., additional, Gevers, T.J., additional, Drenth, J., additional, Guichelaar, M., additional, Bouma, G., additional, Schreuder, T.C.M.A., additional, van der Wouden, E.J., additional, Baak, L.C., additional, Stadhouders, P., additional, Klemt-Kropp, M., additional, Verhagen, M., additional, Bhalla, A., additional, Kuijvenhoven, J., additional, Almasio, P., additional, Alvarez, F., additional, Andrade, R., additional, Arikan, C., additional, Assis, D., additional, Bardou-Jacquet, E., additional, Biewenga, M., additional, Cancado, E., additional, Cazzagon, N., additional, Chazouillères, O., additional, Colloredo, G., additional, Cuarterolo, M., additional, Dalekos, G., additional, Debray, D., additional, Robles-Díaz, M., additional, Dyson, J., additional, Efe, C., additional, Engel, B., additional, Ferri, S., additional, Fontana, R., additional, Gatselis, N., additional, Gerussi, A., additional, Halilbasic, E., additional, Halliday, N., additional, Heneghan, M., additional, Hirschfield, G., additional, van Hoek, B., additional, Hørby Jørgensen, M., additional, Indolfini, G., additional, Iorio, R., additional, Invernizzi, P., additional, Jeong, S., additional, Jones, D., additional, Kelly, D., additional, Kerkar, N., additional, Lacaille, F., additional, Lammert, C., additional, Leggett, B., additional, Lenzi, M., additional, Levy, C., additional, Liberal, R., additional, Lleo, A., additional, Lohse, A., additional, Lopez, S. Ines, additional, de Martin, E., additional, McLin, V., additional, Mieli-Vergani, G., additional, Milkiewicz, P., additional, Mohan, N., additional, Muratori, L., additional, Nebbia, G., additional, van Nieuwkerk, C., additional, Oo, Y., additional, Ortega, A., additional, Páres, A., additional, Pop, T., additional, Pratt, D., additional, Purnak, T., additional, Ranucci, G., additional, Rushbrook, S., additional, Schramm, C., additional, Stättermayer, A., additional, Swain, M., additional, Tanaka, A., additional, Taubert, R., additional, Terrabuio, D., additional, Terziroli, B., additional, Trauner, M., additional, Valentino, P., additional, van den Brand, F., additional, Vergani, D., additional, Villamil, A., additional, Wahlin, S., additional, Ytting, H., additional, Zachou, K., additional, and Zeniya, M., additional
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- 2023
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8. Importance of complete response for outcomes of pregnancy in patients with autoimmune hepatitis
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Fischer, Susan E., de Vries, Elsemieke S., Tushuizen, Maarten E., de Boer, Ynto S., van der Meer, Adriaan J.P., de Man, Robert A., Brouwer, Johannes T., Kuyvenhoven, Johan P., Klemt-Kropp, Michael, Gevers, Tom J.G., Tjwa, Eric T.T.L., Kuiper, Edith M.M., Verhagen, Marc A.M.T., Friederich, Philip W., van Hoek, Bart, Fischer, Susan E., de Vries, Elsemieke S., Tushuizen, Maarten E., de Boer, Ynto S., van der Meer, Adriaan J.P., de Man, Robert A., Brouwer, Johannes T., Kuyvenhoven, Johan P., Klemt-Kropp, Michael, Gevers, Tom J.G., Tjwa, Eric T.T.L., Kuiper, Edith M.M., Verhagen, Marc A.M.T., Friederich, Philip W., and van Hoek, Bart
- Abstract
Background and Aims: While some articles describe outcome of pregnancy in autoimmune hepatitis (AIH), there are less data evaluating influence of AIH control on maternal and perinatal outcomes. This study analysed outcomes of pregnancy and related possible risk factors in AIH. Method: A retrospective multicentre cohort study on pregnancy in AIH was performed in 11 hospitals in the Netherlands. Maternal and neonatal outcomes were collected from records and completed by interview. Risk factors—including incomplete response, relapse and cirrhosis—for adverse outcomes were identified using logistic regression analysis. Results: Ninety-seven pregnancies in 50 women resulted in 70 deliveries (72%) with a live birth rate of 98.5%. AIH relapse occurred in 6% during pregnancy, and in 27% of post-partum episodes. Absence of complete biochemical response at conception was identified as risk factor for the occurrence of gestational and post-partum relapses. Relapse of AIH in the year before conception was a risk factor for the occurrence of both gestational relapses and post-partum relapses. No complete biochemical response increased the risk for hypertensive disorders during pregnancy and intrahepatic cholestasis of pregnancy (ICP). Cirrhosis was found to be a risk factor for miscarriages, but not for other outcomes. Conclusion: Pregnancy in AIH is related to an increased incidence of maternal and fetal/neonatal complications; in most cases, outcome is good. Incomplete biochemical response at conception or relapse in the year before conception are risk factors for gestational and post-partum relapses, for hypertensive disorders and for ICP. Cirrhosis was a risk factor for miscarriages.
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- 2023
9. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report
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Andrade, Raúl J, Aithal, Guruprasad P; https://orcid.org/0000-0003-3924-4830, de Boer, Ynto S; https://orcid.org/0000-0002-4066-7593, Liberal, Rodrigo, Gerbes, Alexander; https://orcid.org/0000-0003-0440-7417, Regev, Arie, Terziroli Beretta-Piccoli, Benedetta, Schramm, Christoph; https://orcid.org/0000-0002-4264-1928, Kleiner, David E; https://orcid.org/0000-0003-3442-4453, De Martin, Eleonora, Kullak-Ublick, Gerd A; https://orcid.org/0000-0002-0757-4408, Stirnimann, Guido; https://orcid.org/0000-0002-8215-4489, Devarbhavi, Harshad; https://orcid.org/0000-0002-3593-3746, Vierling, John M, Manns, Michael P, Sebode, Marcial; https://orcid.org/0000-0002-5163-6979, Londoño, Maria Carlota, Avigan, Mark, Robles-Diaz, Mercedes; https://orcid.org/0000-0002-2365-2787, García-Cortes, Miren, Atallah, Edmond; https://orcid.org/0000-0002-7341-9174, Heneghan, Michael, Chalasani, Naga, Trivedi, Palak J, Hayashi, Paul H; https://orcid.org/0000-0002-5371-1020, Taubert, Richard; https://orcid.org/0000-0001-9270-2496, Fontana, Robert J, Weber, Sabine; https://orcid.org/0000-0001-7077-8078, Oo, Ye Htun; https://orcid.org/0000-0002-0495-6734, Zen, Yoh; https://orcid.org/0000-0001-8370-6508, et al, IAIHG Consortium, EASL DHILI Consortium, Andrade, Raúl J, Aithal, Guruprasad P; https://orcid.org/0000-0003-3924-4830, de Boer, Ynto S; https://orcid.org/0000-0002-4066-7593, Liberal, Rodrigo, Gerbes, Alexander; https://orcid.org/0000-0003-0440-7417, Regev, Arie, Terziroli Beretta-Piccoli, Benedetta, Schramm, Christoph; https://orcid.org/0000-0002-4264-1928, Kleiner, David E; https://orcid.org/0000-0003-3442-4453, De Martin, Eleonora, Kullak-Ublick, Gerd A; https://orcid.org/0000-0002-0757-4408, Stirnimann, Guido; https://orcid.org/0000-0002-8215-4489, Devarbhavi, Harshad; https://orcid.org/0000-0002-3593-3746, Vierling, John M, Manns, Michael P, Sebode, Marcial; https://orcid.org/0000-0002-5163-6979, Londoño, Maria Carlota, Avigan, Mark, Robles-Diaz, Mercedes; https://orcid.org/0000-0002-2365-2787, García-Cortes, Miren, Atallah, Edmond; https://orcid.org/0000-0002-7341-9174, Heneghan, Michael, Chalasani, Naga, Trivedi, Palak J, Hayashi, Paul H; https://orcid.org/0000-0002-5371-1020, Taubert, Richard; https://orcid.org/0000-0001-9270-2496, Fontana, Robert J, Weber, Sabine; https://orcid.org/0000-0001-7077-8078, Oo, Ye Htun; https://orcid.org/0000-0002-0495-6734, Zen, Yoh; https://orcid.org/0000-0001-8370-6508, et al, IAIHG Consortium, and EASL DHILI Consortium
- Abstract
Drug-induced liver injury (DILI) can mimic almost all other liver disorders. A phenotype increasingly ascribed to drugs is autoimmune-like hepatitis (ALH). This article summarises the major topics discussed at a joint International Conference held between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group. DI-ALH is a liver injury with laboratory and/or histological features that may be indistinguishable from those of autoimmune hepatitis (AIH). Previous studies have revealed that patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features. Differentiating DI-ALH from AIH is important as patients with DI-ALH rarely require long-term immunosuppression and the condition often resolves spontaneously after withdrawal of the implicated drug, whereas patients with AIH mostly require long-term immunosuppression. Therefore, revision of the diagnosis on long-term follow-up may be necessary in some cases. More than 40 different drugs including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, herbal and dietary supplements (such as Khat and Tinospora cordifolia) have been implicated in DI-ALH. Understanding of DI-ALH is limited by the lack of specific markers of the disease that could allow for a precise diagnosis, while there is similarly no single feature which is diagnostic of AIH. We propose a management algorithm for patients with liver injury and an autoimmune phenotype. There is an urgent need to prospectively evaluate patients with DI-ALH systematically to enable definitive characterisation of this condition.
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- 2023
10. Importance of complete response for outcomes of pregnancy in patients with autoimmune hepatitis
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Fischer, Susan E., primary, de Vries, Elsemieke S., additional, Tushuizen, Maarten E., additional, de Boer, Ynto S., additional, van der Meer, Adriaan J. P., additional, de Man, Robert A., additional, Brouwer, Johannes T., additional, Kuyvenhoven, Johan P., additional, Klemt‐Kropp, Michael, additional, Gevers, Tom J. G., additional, Tjwa, Eric T. T. L., additional, Kuiper, Edith M. M., additional, Verhagen, Marc A. M. T., additional, Friederich, Philip W., additional, and van Hoek, Bart, additional
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- 2023
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11. Additional file 1 of Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial): study protocol for a randomised controlled trial
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Snijders, Romée J. A. L. M., Stoelinga, Anna E. C., Gevers, Tom J. G., Pape, Simon, Biewenga, Maaike, Verdonk, Robert C., de Jonge, Hendrik J. M., Vrolijk, Jan Maarten, Bakker, Sjoerd F., Vanwolleghem, Thomas, de Boer, Ynto S., Pronk, Martine A. M. C. Baven, Beuers, Ulrich H. W., van der Meer, Adriaan J., van Gerven, Nicole M. F., Sijtsma, Marijn G. M., Verwer, Bart J., Gisbertz, Ingrid A. M., Bartelink, Maartje, van den Brand, Floris F., Sebib Korkmaz, Kerem, van den Berg, Aad P., Guichelaar, Maureen M. J., Soufidi, Khalida, Levens, Amar D., van Hoek, Bart, and Drenth, Joost P. H.
- Abstract
Additional file 1. Spirit checklist.
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- 2023
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12. Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial): study protocol for a randomised controlled trial
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Snijders*, Romée, primary, Stoelinga*, Anna EC, additional, Gevers, Tom JG, additional, Pape, Simon, additional, Biewenga, Maaike, additional, Verdonk, Robert C, additional, de Jonge, Hendrik JM, additional, Vrolijk, Jan Maarten, additional, Bakker, Sjoerd F, additional, Vanwolleghem, Thomas, additional, de Boer, Ynto S, additional, Pronk, Martine AMC Baven, additional, Beuers, Ulrich HW, additional, Meer, Adriaan J van der, additional, Gerven, Nicole MF van, additional, Sijtsma, Marijn GM, additional, Verwer, Bart J, additional, Gisbertz, Ingrid AM, additional, Bartelink, Maartje, additional, Brand, Floris F van den, additional, Korkmaz, Kerem Sebib, additional, Berg, Aad P van den, additional, Guichelaar, Maureen MJ, additional, Soufidi, Khalida, additional, Levens, Amar D, additional, Hoek*, Bart van, additional, and Drenth*, Joost PH, additional
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- 2022
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13. Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial):study protocol for a randomised controlled trial
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Snijders, Romée J.A.L.M., Stoelinga, Anna E.C., Gevers, Tom J.G., Pape, Simon, Biewenga, Maaike, Verdonk, Robert C., de Jonge, Hendrik J.M., Vrolijk, Jan Maarten, Bakker, Sjoerd F., Vanwolleghem, Thomas, de Boer, Ynto S., Pronk, Martine A.M.C.Baven, Beuers, Ulrich H.W., van der Meer, Adriaan J., van Gerven, Nicole M.F., Sijtsma, Marijn G.M., Verwer, Bart J., Gisbertz, Ingrid A.M., Bartelink, Maartje, van den Brand, Floris F., Sebib Korkmaz, Kerem, van den Berg, Aad P., Guichelaar, Maureen M.J., Soufidi, Khalida, Levens, Amar D., van Hoek, Bart, Drenth, Joost P.H., Snijders, Romée J.A.L.M., Stoelinga, Anna E.C., Gevers, Tom J.G., Pape, Simon, Biewenga, Maaike, Verdonk, Robert C., de Jonge, Hendrik J.M., Vrolijk, Jan Maarten, Bakker, Sjoerd F., Vanwolleghem, Thomas, de Boer, Ynto S., Pronk, Martine A.M.C.Baven, Beuers, Ulrich H.W., van der Meer, Adriaan J., van Gerven, Nicole M.F., Sijtsma, Marijn G.M., Verwer, Bart J., Gisbertz, Ingrid A.M., Bartelink, Maartje, van den Brand, Floris F., Sebib Korkmaz, Kerem, van den Berg, Aad P., Guichelaar, Maureen M.J., Soufidi, Khalida, Levens, Amar D., van Hoek, Bart, and Drenth, Joost P.H.
- Abstract
Background: Currently, the standard therapy for autoimmune hepatitis (AIH) consists of a combination of prednisolone and azathioprine. However, 15% of patients are intolerant to azathioprine which necessitates cessation of azathioprine or changes in therapy. In addition, not all patients achieve complete biochemical response (CR). Uncontrolled data indicate that mycophenolate mofetil (MMF) can induce CR in a majority of patients. Better understanding of first-line treatment and robust evidence from randomised clinical trials are needed. The aim of this study was to explore the potential benefits of MMF as compared to azathioprine, both combined with prednisolone, as induction therapy in a randomised controlled trial in patients with treatment-naive AIH. Methods: CAMARO is a randomised (1:1), open-label, parallel-group, multicentre superiority trial. All patients with AIH are screened for eligibility. Seventy adult patients with AIH from fourteen centres in the Netherlands and Belgium will be randomised to receive MMF or azathioprine. Both treatment arms will start with prednisolone as induction therapy. The primary outcome is biochemical remission, defined as serum levels of alanine aminotransferase and immunoglobulin G below the upper limit of normal. Secondary outcomes include safety and tolerability of MMF and azathioprine, time to remission, changes in Model For End-Stage Liver Disease (MELD)-score, adverse events, and aspects of quality of life. The study period will last for 24 weeks. Discussion: The CAMARO trial investigates whether treatment with MMF and prednisolone increases the proportion of patients in remission compared with azathioprine and prednisolone as the current standard treatment strategy. In addition, we reflect on the challenges of conducting a randomized trial in rare diseases. Trial registration: EudraCT 2016-001038-91. Prospectively registered on 18 April 2016. Graphical Abstract: [Figure not available: see fulltext.].
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- 2022
14. Reply: Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome—First report of the IAIHG retrospective registry.
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Slooter, Charlotte D., van den Brand, Floris F., Lleo, Ana, Liberal, Rodrigo, and de Boer, Ynto S.
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- 2024
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15. Diagnostic criteria and long-term outcomes in AIH-PBC variant syndrome under combination therapy.
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Stoelinga AEC, Biewenga M, Drenth JPH, Verhelst X, van der Meer AJP, de Boer YS, Bouma G, de Vries ES, Verdonk RC, van der Berg AP, Brouwer JT, Vanwolleghem T, Lammers W, Beuers U, Sarasqueta AF, Verheij J, Roskams T, Crobach S, Tushuizen ME, and van Hoek B
- Abstract
Background & Aims: Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) can co-exist in AIH-PBC, requiring combined treatment with immunosuppression and ursodeoxycholic acid (UDCA). The Paris criteria are commonly used to identify these patients; however, the optimal diagnostic criteria are unknown. We aimed to evaluate the use and clinical relevance of both Paris and Zhang criteria., Methods: Eighty-three patients with a clinical suspicion of AIH-PBC who were treated with combination therapy were included. Histology was re-evaluated. Characteristics and long-term outcomes were retrospectively compared to patients with AIH and PBC., Results: Seventeen (24%) patients treated with combination therapy fulfilled the Paris criteria. Fifty-two patients (70%) fulfilled the Zhang criteria. Patients who met Paris and Zhang criteria more often had inflammation and fibrosis on histology compared to patients only meeting the Zhang criteria. Ten-year liver transplant (LT)-free survival was 87.3% (95% CI 78.9-95.7%) in patients with AIH-PBC. This did not differ in patients in or outside the Paris or Zhang criteria ( p = 0.46 and p = 0.40, respectively) or from AIH ( p = 0.086). LT-free survival was significantly lower in patients with PBC and severe hepatic inflammation - not receiving immunosuppression - compared to those with AIH-PBC (65%; 95% CI 52.2-77.8% vs . 87%; 95% CI 83.2-90.8%; hazard ratio 0.52; p = 0.043)., Conclusions: In this study, patients with AIH-PBC outside Paris or Zhang criteria were frequently labeled as having AIH-PBC and were successfully treated with combination therapy with similar outcomes. LT-free survival was worse in patients with PBC and hepatic inflammation than in those treated as having AIH-PBC. More patients may benefit from combination therapy., Impact and Implications: This study demonstrated that patients with AIH-PBC variant syndrome treated with combined therapy consisting of immunosuppressants and ursodeoxycholic acid often do not fulfill the Paris criteria. They do however have comparable response to therapy and long-term outcomes as patients who do fulfill the diagnostic criteria. Additionally, patients with PBC and additional signs of hepatic inflammation have poorer long-term outcomes compared to patients treated as having AIH-PBC. These results implicate that a larger group of patients with features of both AIH and PBC may benefit from combined treatment. With our results, we call for improved consensus among experts in the field on the diagnosis and management of AIH-PBC variant syndrome., (© 2024 The Author(s).)
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- 2024
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16. Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome: First report of the IAIHG retrospective registry.
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Slooter CD, van den Brand FF, Lleo A, Colapietro F, Lenzi M, Muratori P, Kerkar N, Dalekos GN, Zachou K, Lucena MI, Robles-Díaz M, Di Zeo-Sánchez DE, Andrade RJ, Montano-Loza AJ, Lytvyak E, Lissenberg-Witte BI, Maisonneuve P, Bouma G, Macedo G, Liberal R, and de Boer YS
- Subjects
- Humans, Retrospective Studies, Liver Cirrhosis complications, Pathologic Complete Response, Hepatitis, Autoimmune diagnosis, Liver Transplantation, Cholangitis, Sclerosing complications
- Abstract
Background and Aims: The International Autoimmune Hepatitis Group retrospective registry (IAIHG-RR) is a web-based platform with subjects enrolled with a clinical diagnosis of autoimmune hepatitis (AIH). As prognostic factor studies with enough power are scarce, this study aimed to ascertain data quality and identify prognostic factors in the IAIHG-RR cohort., Methods: This retrospective, observational, multicenter study included all patients with a clinical diagnosis of AIH from the IAIHG-RR. The quality assessment consisted of external validation of completeness and consistency for 29 predefined variables. Cox regression was used to identify risk factors for liver-related death and liver transplantation (LT)., Results: This analysis included 2559 patients across 7 countries. In 1700 patients, follow-up was available, with a completeness of individual data of 90% (range: 30-100). During a median follow-up period of 10 (range: 0-49) years, there were 229 deaths, of which 116 were liver-related, and 143 patients underwent LT. Non-White ethnicity (HR 4.1 95% CI: 2.3-7.1), cirrhosis (HR 3.5 95% CI: 2.3-5.5), variant syndrome with primary sclerosing cholangitis (PSC) (HR 3.1 95% CI: 1.6-6.2), and lack of complete biochemical response within 6 months (HR 5.7 95% CI: 3.4-9.6) were independent prognostic factors., Conclusions: The IAIHG-RR represents the world's largest AIH cohort with moderate-to-good data quality and a relevant number of liver-related events. The registry is a suitable platform for patient selection in future studies. Lack of complete biochemical response to treatment, non-White ethnicity, cirrhosis, and PSC-AIH were associated with liver-related death and LT., (Copyright © 2023 American Association for the Study of Liver Diseases.)
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- 2024
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17. Incidence and predictors of hepatocellular carcinoma in patients with autoimmune hepatitis.
- Author
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Colapietro F, Maisonneuve P, Lytvyak E, Beuers U, Verdonk RC, van der Meer AJ, van Hoek B, Kuiken SD, Brouwer JT, Muratori P, Aghemo A, Carella F, van den Berg AP, Zachou K, Dalekos GN, Di Zeo-Sánchez DE, Robles M, Andrade RJ, Montano-Loza AJ, van den Brand FF, Slooter CD, Macedo G, Liberal R, de Boer YS, and Lleo A
- Subjects
- Humans, Incidence, Liver Cirrhosis complications, Liver Cirrhosis epidemiology, Obesity complications, Retrospective Studies, Risk Factors, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular etiology, Carcinoma, Hepatocellular diagnosis, Hepatitis, Autoimmune complications, Hepatitis, Autoimmune epidemiology, Hepatitis, Autoimmune diagnosis, Liver Neoplasms epidemiology, Liver Neoplasms etiology, Liver Neoplasms diagnosis
- Abstract
Background and Aims: Autoimmune hepatitis (AIH) is a rare chronic liver disease of unknown aetiology; the risk of hepatocellular carcinoma (HCC) remains unclear and risk factors are not well-defined. We aimed to investigate the risk of HCC across a multicentre AIH cohort and to identify predictive factors., Methods: We performed a retrospective, observational, multicentric study of patients included in the International Autoimmune Hepatitis Group Retrospective Registry. The assessed clinical outcomes were HCC development, liver transplantation, and death. Fine and Gray regression analysis stratified by centre was applied to determine the effects of individual covariates; the cumulative incidence of HCC was estimated using the competing risk method with death as a competing risk., Results: A total of 1,428 patients diagnosed with AIH from 1980 to 2020 from 22 eligible centres across Europe and Canada were included, with a median follow-up of 11.1 years (interquartile range 5.2-15.9). Two hundred and ninety-three (20.5%) patients had cirrhosis at diagnosis. During follow-up, 24 patients developed HCC (1.7%), an incidence rate of 1.44 cases/1,000 patient-years; the cumulative incidence of HCC increased over time (0.6% at 5 years, 0.9% at 10 years, 2.7% at 20 years, and 6.6% at 30 years of follow-up). Patients who developed cirrhosis during follow-up had a significantly higher incidence of HCC. The cumulative incidence of HCC was 2.6%, 4.6%, 5.6% and 6.6% at 5, 10, 15, and 20 years after the development of cirrhosis, respectively. Obesity (hazard ratio [HR] 2.94, p = 0.04), cirrhosis (HR 3.17, p = 0.01), and AIH/PSC variant syndrome (HR 5.18, p = 0.007) at baseline were independent risk factors for HCC development., Conclusions: HCC incidence in AIH is low even after cirrhosis development and is associated with risk factors including obesity, cirrhosis, and AIH/PSC variant syndrome., Impact and Implications: The risk of developing hepatocellular carcinoma (HCC) in individuals with autoimmune hepatitis (AIH) seems to be lower than for other aetiologies of chronic liver disease. Yet, solid data for this specific patient group remain elusive, given that most of the existing evidence comes from small, single-centre studies. In our study, we found that HCC incidence in patients with AIH is low even after the onset of cirrhosis. Additionally, factors such as advanced age, obesity, cirrhosis, alcohol consumption, and the presence of the AIH/PSC variant syndrome at the time of AIH diagnosis are linked to a higher risk of HCC. Based on these findings, there seems to be merit in adopting a specialized HCC monitoring programme for patients with AIH based on their individual risk factors., (Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2024
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18. Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice.
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Vanella G, Bronswijk M, Arcidiacono PG, Larghi A, Wanrooij RLJV, de Boer YS, Rimbas M, Khashab M, and van der Merwe SW
- Abstract
Therapeutic EUS has witnessed exponential growth in the last decade, but it has been considered investigational until recently. An increasing body of good-quality evidence is now demonstrating clear advantages over established alternatives, adding therapeutic EUS to management algorithms of complex hepato-pancreato-biliary (HPB) and gastrointestinal (GI) conditions. In this review, the available evidence and clinical role of therapeutic EUS in established and evolving applications will be discussed. A Graphical Summary for each scenario will provide (1) technical steps, (2) anatomical sketch, (3) best-supporting evidence, and (4) role in changing current and future GI practice. Therapeutic EUS has accepted well-established applications such as drainage of symptomatic peripancreatic fluid collections, biliary drainage in failed endoscopic retrograde cholangiopancreatography, and treatment of acute cholecystitis in unfit-for-surgery patients. In addition, good-quality evidence on several emerging indications (e.g., treatment of gastric outlet obstruction, local ablation of pancreatic solid lesions, etc.) is promising. Specific emphasis will be given to how these technical innovations have changed management paradigms and algorithms and expanded the possibilities of gastroenterologists to provide therapeutic solutions to old and emerging clinical needs. Therapeutic EUS is cementing its role in everyday practice, radically changing the treatment of different HPB diseases and other conditions (e.g., GI obstruction). The development of dedicated accessories and increased training opportunities will expand the ability of gastroenterologists to deliver highly effective yet minimally invasive therapies, potentially translating into a better quality of life, especially for oncological and fragile patients., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
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