Is Budesonide effective as first-line therapy in autoimmune hepatitis?

The key findings of this study were:

1. Prednisone patients had a considerably greater BR rate (87% vs. 49% of patients receiving budesonide, p = 0.001) than those receiving budesonide.

2. At any point throughout follow-up as well as at 6 and 12 months after treatment began, the chance of obtaining BR, as measured by the inverse probability of treatment weighted propensity score, was considerably lower in the budesonide group.

3. In individuals with transaminases 2 upper limit of normality (ULN), BR was comparable across the two therapy groups.

4. A greater risk of adverse events was substantially related with prednisone administration (24.2% vs. 15.9%, p = 0.047).

A decreased incidence of adverse events was linked to budesonide. Although there was no baseline predictor of response found, prednisone-treated individuals had a greater likelihood of BR when their alanine aminotransferase (ALT) or ALT + aspartate aminotransferase (AST) levels dropped quickly. Low transaminase levels at diagnosis (2 ULN) patients had comparable BR with both corticosteroid therapies and may benefit from the less adverse events (AEs) linked to budesonide therapy.

Reference:

Díaz-González, Á., Hernández-Guerra, M., Pérez-Medrano, I., Sapena, V., Riveiro-Barciela, M., Barreira-Díaz, A., Gómez, E., Morillas, R. M., Del Barrio, M., Escudé, L., Mateos, B., Arencibía, A., Zamora, J., … Fernández, A. (2023). Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration. In Hepatology (Vol. 77, Issue 4, pp. 1095–1105). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/hep.0000000000000018