{
  "abstract": "Background and Aims Evidence regarding the short- and long-term efficacy and safety of third-line therapies in autoimmune hepatitis (AIH) remains limited. We aimed to evaluate both the efficacy and safety outcomes of third-line agents.Method We conducted a retrospective review of 704 AIH patients treated at our tertiary liver center between 1975 and May 2024. Patients who received third-line therapy for at least six months were included in the analysis.Results Of the 93 included patients, 74 (79.6%) were female, with a median age of 47 years (IQR 30–63.7). Twenty-eight percent of patients were not exposed to thiopurines. Mycophenolate mofetil (MMF) was initiated in 68 patients (73.1%). MMF treatment was discontinued in nine patients due to side effects, seven for family planning, and three due to lack of efficacy. Median follow-up time on MMF was 168 months (23.1–168). Biochemical response was 53.0% at 6 months and 64.0% at 12 months. Transaminase normalisation was achieved in 59.1% at 6 months and 68.9% at 12 months. Tacrolimus (TAC) was used in 51 patients (54.8%); four discontinued treatments (in one patient due clinical trial enrolment, one due to HPV-related cervical intraepithelial neoplasia, one for inefficacy, and one due to cytopenia), with a median follow-up time of 59.4 months (14.2–62.8). Biochemical response was 37.0% at 6 months and 34.2% at 12 months. Transaminase normalisation was achieved in 40.5% at 6 months and 42.1% at 12 months. No increased risk of renal dysfunction or metabolic complications — including diabetes, prediabetes, and hyperlipidaemia — was observed in patients receiving TAC.Triple therapy was used in 18 patients (19.4%), most commonly a combination of TAC, steroids, and MMF, with a median treatment duration of 62.4 months (26.4–139.6). Biochemical response was 37.5% at 6 months and 31.2% at 12 months. Transaminase normalisation was achieved in 37.5% at both 6 and months.Median clinical event-free survival was 148.3 months (48–189.3) in patients treated with MMF (n = 42, including 14 not exposed to AZA), 53.5 months (18.5–85.2) in patients treated with TAC (n = 33, including 5 not exposed to AZA) and 59.7 months (22.2–119.1) in patients treated with triple therapy (n = 18). Two cases of viremia, two abscesses, two chest infections, and one fungal nail infection were noted during follow-up.Abstract O9 Figure 1Conclusion In this single-centre cohort of difficult-to-treat AIH patients, third-line therapies showed favourable short- and long-term outcomes, including improved biochemistry, prolonged event-free survival, and good safety profile.",
  "authors": [
    {
      "affiliations": [
        "King’s College Hospital, UK"
      ],
      "name": "Ilkay Ergenc"
    },
    {
      "affiliations": [
        "University of Calgary, Canada"
      ],
      "name": "Alexandra Frolkis"
    },
    {
      "affiliations": [
        "King’s College Hospital, UK"
      ],
      "name": "Yooyun Chung"
    },
    {
      "affiliations": [
        "King’s College Hospital, UK"
      ],
      "name": "Yoh Zen"
    },
    {
      "affiliations": [
        "King’s College Hospital, UK"
      ],
      "name": "Deepak Joshi"
    },
    {
      "affiliations": [
        "King’s College Hospital, UK"
      ],
      "name": "Michael Heneghan"
    }
  ],
  "title": "O9 Efficacy and safety of third-line therapies in autoimmune hepatitis: short- and long-term outcomes from a real-world cohort",
  "uid": "2bee0aa0-8ccc-57ca-9c9d-9f2ee60a4939"
}