Isolated IgG elevation in patients with persistently normal transaminases does not affect the outcome of autoimmune hepatitis
Díaz-González, Álvaro (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Schregel, Ida (University Medical Center Hamburg-Eppendorf)
Carballo, Lorena (Hospital Universitario Central de Asturias)
Álvarez-Navascués, Carmen (Hospital Universitario Central de Asturias)
Frisancho-Morales, Enrique (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Miquel Planas, Mireia (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Retortillo, Montserrat García (Parc de Salut MAR de Barcelona)
Gómez, Judith (Hospital Universitario de Burgos)
Horta Sangenís, Diana (Hospital Universitari MútuaTerrassa)
Mateos Muñoz, Beatriz (Hospital Universitario Ramón y Cajal (Madrid))
Engel, Bastian (Hannover Medical School)
Volmer, Felix (Hannover Medical School)
Barrio, María del (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Rodríguez-Tajes, Sergio (Universitat de Barcelona)
Olivas, Ignasi (Universitat de Barcelona)
Hartl, Johannes (University Medical Center Hamburg-Eppendorf)
González, Carla Amaral (Hospital Universitario de Canarias (La Laguna))
Hernandez-Guerra, Manuel (Hospital Universitario de Canarias (La Laguna))
Castello, Inmaculada (Hospital General Universitario de Valencia)
Pérez-Medrano, Indhira (Complejo Hospitalario Universitario de Pontevedra)
González Santiago, Jesús M. (Complejo Asistencial Universitario de Salamanca)
Arencibía, Ana (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Gómez, Alberto (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Rodríguez-Perálvarez, Manuel (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Crespo García, Javier (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Sala, Margarita (Hospital Universitari de Girona Doctor Josep Trueta)
Salcedo, Magdalena (Hospital General Universitario Gregorio Marañón)
Barreira-Diaz, Ana (Hospital Universitari Vall d'Hebron)
Riveiro Barciela, Mar (Hospital Universitari Vall d'Hebron)
Taubert, Richard (Hannover Medical School)
Schramm, Christoph (University Medical Center Hamburg-Eppendorf)
Londoño, María-Carlota (Universitat de Barcelona)

Fecha:	2025
Resumen:	The goal of treatment for autoimmune hepatitis is to achieve a complete biochemical response, defined as normalization of transaminases and immunoglobulin G (IgG) levels. Recent data suggest that IgG normalization does not significantly affect survival. We evaluated the impact of persistently elevated IgG levels (IgGe) and IgG flares (IgGf) on fibrosis progression and cirrhosis development. This retrospective multicenter cohort study included 493 patients with autoimmune hepatitis and persistently normal transaminase levels during follow-up. The inverse probability of treatment weighting (IPTW) propensity score method was used to balance the cohorts. Three hundred forty-nine (70. 8%) patients had persistently normal IgG (IgGn) levels, 89 (18. 1%) had IgGe, and 55 (11. 1%) had IgGf during follow-up. After a median follow-up of 6. 2 years (IQR 4. 1-10. 1 years) with normal transaminase levels, median liver stiffness measurement (LSM) values remained stable, with no significant differences between groups. During the follow-up, 24 patients developed cirrhosis. Predictive factors for cirrhosis were age (hazard ratio [HR] 1. 10, p. <0. 001), albumin (HR 0. 20, p <0. 001), IgG (HR 1. 00, p = 0. 001), and platelet count (HR 0. 99, p = 0. 001) at diagnosis; LSM (HR 1. 30, p <0. 001) at transaminase normalization; and transaminase normalization at 6 months (HR 0. 24, p = 0. 025). In the multivariate analysis, only LSM was independently associated with a higher risk of developing cirrhosis. After IPTW application, elevated IgG (IgGe or IgGf) did not affect fibrosis progression (p = 0. 275) or cirrhosis development (p = 0. 211). Conclusions: Persistent or temporary serum IgG elevation in patients with normal transaminase levels did not significantly affect autoimmune hepatitis disease progression, thus challenging the current definition of complete biochemical response.
Ayudas:	Instituto de Salud Carlos III PI21/00800
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Autoimmune hepatitis ; Complete biochemical response ; Immunoglobulin G
Publicado en:	JHEP Reports, Vol. 7, Num. 11 (August 2025) , art. 101562, ISSN 2589-5559

DOI: 10.1016/j.jhepr.2025.101562
PMID: 41098242

9 p, 920.8 KB

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