{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:45:52Z","timestamp":1792039552144,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Autoimmune hepatitis (AIH) requires corticosteroid\u2010based induction therapy, but prolonged exposure is common in practice.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n This study quantified corticosteroid utilization patterns and associations with adverse outcomes from a patient perspective.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A cross\u2010sectional patient\u2010reported survey recruited AIHA network members with physician\u2010confirmed AIH (\n N<\/jats:italic>\n \u2009=\u2009563). Corticosteroid exposure was quantified using annual duration thresholds (\u2265\u200990\u2009days\/year at \u2265\u20095\u2009mg\/day prednisone\u2010equivalent). Early side effects (within 6\u2009months;\n n<\/jats:italic>\n \u2009=\u2009491) and long\u2010term metabolic complications (\u2265\u20092\u2009years disease duration;\n n<\/jats:italic>\n \u2009=\u2009385) were assessed using multivariable logistic regression adjusting for age, sex and disease duration.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 563 participants (median age 53\u2009years; 87.4% female), all participants received a corticosteroid at diagnosis (77.6% prednisone; 11.4% budesonide). Side effects within 6\u2009months were near\u2010universal (96.6%; median 5 symptoms) and greater with predniso(lo)ne than budesonide (5.82 vs. 3.55 symptoms;\n p<\/jats:italic>\n \u2009<\u20090.001); 51.2% of predniso(lo)ne\u2010initiated patients developed a new metabolic condition within 6\u2009months. Long\u2010term complications affected 75.9% of the chronically exposed cohort, including weight gain >\u20095% (47.0%), osteoporosis (30.4%) and hypertension (18.1%). Each additional cumulative year of extensive exposure was independently associated with the composite adverse outcome (adjusted OR 1.11, 95% CI 1.02\u20131.22;\n p<\/jats:italic>\n \u2009=\u20090.014), osteoporosis, Type 2 diabetes, weight gain and cataracts, with significant dose\u2013response gradients (\n p<\/jats:italic>\n \u2010trend\u2009\u2264\u20090.008). Patients with >\u20095 cumulative years had 4\u2010fold higher odds of the composite outcome versus patients in the None exposure group (OR 4.21, 95% CI 1.51\u201311.71).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Corticosteroid exposure in AIH is associated with dose\u2010dependent toxicity from the first months of treatment. Reduced induction dosing and budesonide represent potential steroid\u2010minimization strategies in appropriate patients, warranting prospective evaluation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/apt.71044","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:00:47Z","timestamp":1792036847000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Corticosteroid Exposure in Autoimmune Hepatitis: Early Toxicity, Cumulative Burden and Associations With Long\u2010Term Patient\u2010Reported Outcomes"],"prefix":"10.1111","author":[{"given":"Elizabeth","family":"Gentry","sequence":"first","affiliation":[{"name":"Department of Digestive and Liver Diseases Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Woods","sequence":"additional","affiliation":[{"name":"Department of Digestive and Liver Diseases Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9518-5063","authenticated-orcid":false,"given":"Kelsey","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Digestive and Liver Diseases Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Blessing","sequence":"additional","affiliation":[{"name":"Department of Digestive and Liver Diseases Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3809-640X","authenticated-orcid":false,"given":"Craig","family":"Lammert","sequence":"additional","affiliation":[{"name":"Department of Digestive and Liver Diseases Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/hep.31065","article-title":"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","volume":"72","author":"Mack C. 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K.","year":"2017","journal-title":"BMJ"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003432","article-title":"Dose\u2010Dependent Oral Glucocorticoid Cardiovascular Risks in People With Immune\u2010Mediated Inflammatory Diseases: A Population\u2010Based Cohort Study","volume":"17","author":"Pujades\u2010Rodriguez M.","year":"2020","journal-title":"PLoS Medicine"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1093\/rheumatology\/ker017","article-title":"Prevalence of Long\u2010Term Oral Glucocorticoid Prescriptions in the UK Over the Past 20\u2009Years","volume":"50","author":"Fardet L.","year":"2011","journal-title":"Rheumatology (Oxford)"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/acr.21796","article-title":"Prevalence of Oral Glucocorticoid Usage in the United States: A General Population Perspective","volume":"65","author":"Overman R. 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A Nationwide Registry\u2010Based Cohort Study","volume":"60","author":"Gronbaek L.","year":"2014","journal-title":"Journal of Hepatology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.jhep.2015.06.030","article-title":"EASL Clinical Practice Guidelines: Autoimmune Hepatitis","volume":"63","author":"European Association for the Study of the Liver","year":"2015","journal-title":"Journal of Hepatology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/apt.14968","article-title":"Inequity of Care Provision and Outcome Disparity in Autoimmune Hepatitis in the United Kingdom","volume":"48","author":"Dyson J. 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