PLoS ONE (Jan 2015)

Criteria Used in Clinical Practice to Guide Immunosuppressive Treatment in Patients with Primary Sclerosing Cholangitis.

  • Kornelius Schulze,
  • Tobias J Weismüller,
  • Michael Bubenheim,
  • Peter Huebener,
  • Roman Zenouzi,
  • Henrike Lenzen,
  • Christian Rupp,
  • Daniel Gotthardt,
  • Philipp de Leuw,
  • Andreas Teufel,
  • Vincent Zimmer,
  • Florian P Reiter,
  • Christian Rust,
  • Lars Tharun,
  • Alexander Quaas,
  • Sören A Weidemann,
  • Frank Lammert,
  • Christoph Sarrazin,
  • Michael P Manns,
  • Ansgar W Lohse,
  • Christoph Schramm,
  • German PSC Study Group

DOI
https://doi.org/10.1371/journal.pone.0140525
Journal volume & issue
Vol. 10, no. 10
p. e0140525

Abstract

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Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC.This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks.A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.