{
  "abstract": "Introduction Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease. Treatment aims to achieve complete biochemical remission (CBR). Standard therapy includes corticosteroid induction followed by azathioprine (AZA) as steroid-sparing agent. AZA efficacy correlates with 6-thioguanine (6-TGN) levels > 220 pmol/8x10 8 RBC, while elevated 6-methylmercaptopurine nucleotides (6-MMPN) are linked to hepatotoxicity. Allopurinol co-therapy is established in inflammatory bowel disease with limited evidence in AIH.Aims To evaluate treatment strategies, remission rates, and impact of AZA metabolite monitoring in a single-centre AIH cohort, with focus on allopurinol co-therapy.Methods We reviewed a database of 156 patients with confirmed AIH at University Hospitals Dorset. Data included demographics, treatment regimen, remission status, corticosteroid use, and azathioprine metabolite levels. For patients receiving allopurinol, indications for initiation and pre- and post-treatment biochemical and metabolite changes were analysed.Results Ninety-six patients received AZA; 19 were managed with allopurinol co-therapy due to hepatotoxicity (n=13) or intolerance (n=6). Among AZA monotherapy patients (n=77), 54 (70.1%) achieved CBR, 46 (59.7%) achieved steroid-free remission (SFR). In the allopurinol co-therapy group, 15 (78.9%) achieved CBR, 13 (68.4%) achieved SFR. Differences between cohorts were not statistically significant.Fourteen patients were not in CBR at allopurinol initiation; 10 (71%) achieved CBR within nine months, and eight of these were weaned off corticosteroids within 3–12 months. Using paired data (n=18), CBR increased from 4/18 (22.2%) pre-allopurinol to 14/18 (77.8%) post-allopurinol (absolute increase 55.6%, 95% CI 30.8%–78.5%); McNemar’s exact p=0.00195. No patients lost remission. This was associated with a significant rise in 6-TGN and reduction in 6-MMPN levels (p<0.01).Conclusion We present one of the largest UK case series of allopurinol co-therapy in AIH. Although remission rates did not differ significantly between cohorts, co-therapy was associated with improved metabolite profiles, high post-initiation remission, and reduced corticosteroid dependence. Our data supports the use of AZA metabolite monitoring and allopurinol co-therapy in selected patients with AZA intolerance or toxicity. We are now exploring the benefit of transitioning patients on AZA mono-therapy with low TGN levels to allopurinol co-therapy.Abstract P58 Table 1Azathioprine (n=77)Allopurinol co-therapy (n=19)Analysis Fishers exactCBR54 (70.1%)15 (78.9%)p=0.56SFR 46 (59.7%)13 (68.4%)p= 0.59Mann Whitney U 6-TGN pre/post Allopurinol (mean)222.3- 396.2p = 0.00296-MMPN level pre/post allopurinol (mean)4877.1 – 208.5p< 0.001Pre allopurinolPost allopurinolMcNemar’s exact CBR Allopurinol cohort4/1814/18 p < 0.00295% CI (30.8%-78.5%)",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Helen Stone"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "George Read"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Jo Tod"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Christopher John"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Holly Harfield"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Jenna Wooding"
    },
    {
      "affiliations": [
        "University Hospitals Dorset, Bournemouth, United Kingdom"
      ],
      "name": "Safa Al-Shamma"
    }
  ],
  "title": "P58 Use of azathioprine and allopurinol combination therapy to optimise outcomes in autoimmune hepatitis: a single centre experience",
  "uid": "879bfa00-172a-5094-9ed4-c47de555faea"
}