Development of a Autoimmune Hepatitis Patient's Database Linked to a Biological Sample Storage

Official title

Multicenter, Nationwide, Observational, Retrospective and Prospective Study Based on the Development of a Autoimmune Hepatitis Patient's Database Linked to a Biological Sample Storage

Overview

Autoimmune Hepatitis (AIH) is chronic fibroinflammatory disease of the liver characterized by chronic, relapsing liver inflammation, and a risk for progression to liver failure and need for liver transplantation. No AIH-specific registry does exist in Italy, so that the actual epidemiology of the disease in the country is unknown. This is an observational, retrospective and prospective, multicenter study evaluating incidence, prevalence and disease course of AIH in subjects \> 1 years old in Italy.

Detailed description

Autoimmune Hepatitis (AIH) is a chronic fibroinflammatory disease of the liver characterized by chronic, relapsing inflammation, and a risk for progression to liver failure and development of hepatocellular cancer. Both children and adults are affected. A significant fraction of patients with AIH has a diminished life expectancy, despite treatment. Around 80% of patients respond to current therapies, but their quality of life and health is hugely impaired by side effects. The remaining proportion of patients (the difficult-to-treat category) do not respond to treatment and progress to liver cirrhosis and its complications; thus, timely identification of these individuals is a key aspect of epidemiological research in AIH.Taken together and combined with patients' debilitating quality of life issues, these data highlight the considerable disease burden and clinical impact of AIH on patients' outcomes.

Most epidemiological studies on AIH are retrospective case series based on tertiary referral series with relevant selection biases. Population-based studies, that include all cases in a defined geographical area, provide more accurate estimates of incidence, survival and mortality rate for the individual with AIH. Typically, multiple case-finding approaches have been used, including surveys, laboratory reports, liver histology databases, transplant registries, and death certificates. Only few population-based studies have been performed and limit the research population to a few dozen patients, reporting incidence rates ranging from 1.07 to 1.9 per 100,000 inhabitants. Reported point prevalence is 16.9 per 100,000.

To the investigators knowledge, there have been no epidemiologic studies in AIH carried out in Italy.

The investigators aim to develop a national registry on this rare disease to describe incidence and prevalence of AIH in Italy; identify and define distinct phenotypes and sub-phenotypes of AIH patients; identify factors influencing the progression of AIH and affecting mortality; assess safety and long-term efficacy of novel therapies.

This is a multicentre, nationwide, observational and prospective study based on the development of a patient's database linked to a biological sample storage. The enrollment period will cover 120 months to include the required number of patients. Based on litteraure, the estimated prevalence of AIH in Italy ranges from 6,000 to 15,000. Based on this, the investigators estimate to enroll approximately 10,000 patients. The minimum follow-up time will be 1 year.

Interventions

• Other Clinical Information
  We will recruit AIH patients and collect important clinical information and laboratory investigation, together with biological samples.

Primary outcome measures

• Number of participants with Normalization of AST and ALT <1 x upper limit of normal (ULN)) and normal IgG levels within 6 months [Time frame: Overall duration of the study (11 years)]
• Number of participants with lack of biochemical response [Time frame: Overall duration of the study (11 years)]
• Number of participants with <50% decrease of AST and ALT within 4 weeks after initiation of treatment [Time frame: Overall duration of the study (11 years)]
• Number of participants with Hepatitis Activity Index <4/18 [Time frame: Overall duration of the study (11 years)]
• Intolerance to treatment [Time frame: Overall duration of the study (11 years)]
• Deep biochemical remissionof disease progression [Time frame: Overall duration of the study (11 years)]
• Relapse [Time frame: Overall duration of the study (11 years)]
• Number of participants with An increase in serum ALT levels above ULN on at least two occasions with an interval of 4 weeks [Time frame: Overall duration of the study (11 years)]
• Number of participants with variceal bleeding requiring hospital admission [Time frame: Overall duration of the study (11 years)]
• Number of participants with first evidence of ascites requiring hospital admission [Time frame: Overall duration of the study (11 years)]

Secondary outcome measures (3)

• Liver stiffness [Time frame: Overall duration of the study (11 years)]
• Number of participants achieving HAI score < 4 at follow-up biopsies [Time frame: Overall duration of the study (11 years)]
• The time from the diagnosis of AIH to an event [Time frame: Overall duration of the study (11 years)]

Eligibility criteria

Inclusion criteria

• All AIH patients living in Italy and aged at least 1 year can be included in the database.
• Willing and able to give informed consent prior to any study specific procedure being
• Diagnosis of AIH according to the most recent published guidelines (EASL)

Exclusion criteria

• Subject unwilling to participate at the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Italy · 1 center

• Fondazione IRCCS San Gerardo dei Tintori — Monza

Publications

• Heneghan MA, Yeoman AD, Verma S, Smith AD, Longhi MS. Autoimmune hepatitis. Lancet. 2013 Oct 26;382(9902):1433-44. doi: 10.1016/S0140-6736(12)62163-1. Epub 2013 Jun 14. PMID 23768844
• Sharma R, Verna EC, Soderling J, Roelstraete B, Hagstrom H, Ludvigsson JF. Increased Mortality Risk in Autoimmune Hepatitis: A Nationwide Population-Based Cohort Study With Histopathology. Clin Gastroenterol Hepatol. 2021 Dec;19(12):2636-2647.e13. doi: 10.1016/j.cgh.2020.10.006. Epub 2020 Oct 14. PMID 33065308
• Mack CL, Adams D, Assis DN, Kerkar N, Manns MP, Mayo MJ, Vierling JM, Alsawas M, Murad MH, Czaja AJ. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology. 2020 Aug;72(2):671-722. doi: 10.1002/hep.31065. Epub 2020 May 12. No abstract available. PMID 31863477
• Wong LL, Fisher HF, Stocken DD, Rice S, Khanna A, Heneghan MA, Oo YH, Mells G, Kendrick S, Dyson JK, Jones DEJ; UK-AIH Consortium. The Impact of Autoimmune Hepatitis and Its Treatment on Health Utility. Hepatology. 2018 Oct;68(4):1487-1497. doi: 10.1002/hep.30031. PMID 29663477
• Pape S, Snijders RJALM, Gevers TJG, Chazouilleres O, Dalekos GN, Hirschfield GM, Lenzi M, Trauner M, Manns MP, Vierling JM, Montano-Loza AJ, Lohse AW, Schramm C, Drenth JPH, Heneghan MA; International Autoimmune Hepatitis Group (IAIHG) collaborators(double dagger). Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group. J Hepato PMID 35066089
• Heneghan MA, Shumbayawonda E, Dennis A, Ahmed RZ, Rahim MN, Ney M, Smith L, Kelly M, Banerjee R, Culver EL. Quantitative magnetic resonance imaging to aid clinical decision making in autoimmune hepatitis. EClinicalMedicine. 2022 Mar 21;46:101325. doi: 10.1016/j.eclinm.2022.101325. eCollection 2022 Apr. PMID 35340625
• van Gerven NM, Verwer BJ, Witte BI, van Hoek B, Coenraad MJ, van Erpecum KJ, Beuers U, van Buuren HR, de Man RA, Drenth JP, den Ouden JW, Verdonk RC, Koek GH, Brouwer JT, Guichelaar MM, Mulder CJ, van Nieuwkerk KM, Bouma G; Dutch Autoimmune Hepatitis Working Group. Relapse is almost universal after withdrawal of immunosuppressive medication in patients with autoimmune hepatitis in remission. J Hep PMID 22989569

Identifiers

NCT: NCT06078098 · AIH Database

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗