S2376 Current Status of Immunosuppressive Therapies in Autoimmune Hepatitis (AIH): A Meta-Analysis of Clinical Outcomes

Introduction: Autoimmune hepatitis (AIH) covers a range of clinical phenotypes that complicate its management. Azathioprine with or without corticosteroid remains the first line therapy for AIH while other options such as mycophenolate mofetil (MMF) is used in select patients as frontline or salvage therapy. Due to inconsistent reporting of clinical outcomes when using 2 drugs for AIH therapy, we conducted a meta-analysis to investigate efficacy of azathioprine and MMF in AIH patients. Methods: The meta-analysis using RevMan 5.4 was conducted to evaluate outcomes such as complete biochemical response, remission rate and liver related mortality. We calculated risk ratios (RR) or odds ratios (OR), depending on the nature and frequency of events. The Mantel-Haenszel method was employed for pooling effect estimates, and a random-effects model to account for potential clinical and methodological heterogeneity across studies. Inclusion criteria was, randomized controlled trials (RCTs) and comparative cohort studies including adult patients with AIH, reporting related clinical outcomes. Results: After searching through 4 databases, we selected a total of 8 studies (including RCTs and cohort). We compared efficacy and liver related mortality in patients treated with MMF vs azathioprine. For the rate of remission pooled analysis demonstrated (RR = 1.00, 95% CI: 0.42 to 2.40, P = 1.00) indicating comparable likelihood of achieving remission. The data on complete biochemical response at 6 months following initiation of treatment shows (RR = 1.39, 95% CI: 0.62 to 3.12, P = 0.42). The reported data on liver-related mortality among both groups showed (OR = 0.33, 95% CI: 0.01 to 14.18, P = 0.56). All outcomes had high heterogeneity (I² = 75%, I² = 87%, I² = 76% respectively). Conclusion: Our study demonstrates that there are no statistically significant differences among both groups in rates of remission, complete biochemical response, and liver-related mortality in AIH. Confidence interval for all outcomes included the null value suggesting that current evidence does not support a clear advantage of MMF over azathioprine. Current literature has variable findings, some favoring MMF over azathioprine. Our results indicate that superiority of MMF over azathioprine in AIH remains uncertain. However, we recommend larger RCTs with long term follow up to establish potential differences between the 2 immunosuppressive therapies.