{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:01:16Z","timestamp":1792839676570,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T00:00:00Z","timestamp":1591833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003825","name":"Magyar Tudom\u00e1nyos Akad\u00e9mia","doi-asserted-by":"publisher","award":["BO\/00232\/17\/5"],"award-info":[{"award-number":["BO\/00232\/17\/5"]}],"id":[{"id":"10.13039\/501100003825","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guidelines regarding treatment for autoimmune hepatitis (AIH) favour two strategies for azathioprine (AZA) introduction: concurrent with steroids at induction or delayed by 2\u20104\u00a0weeks. The safety and efficacy of both strategies have been unexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We established a cohort of 900 AIH patients from 12 centres in 7 European countries. There were 631 patients who used AZA as part of the therapeutic regimen. We distinguished two groups: patients with early AZA (&lt;2\u00a0weeks) or delayed AZA initiation (\u22652\u00a0weeks). Primary outcome was discontinuation of AZA in the first year of treatment. Cox regression and propensity score matching was performed to determine difference in outcomes between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with early AZA initiation had significantly lower transaminases and bilirubin at baseline. Discontinuation rates of AZA did not differ between early and delayed starters (16.6% vs 14.2%), which did not reach statistical significance (hazard ratio 0.97, 95% confidence interval 0.61\u20101.55,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.90). Stratification according to baseline disease activity or propensity score matching did not alter the results. Main reason for AZA discontinuation was intolerance to treatment (14.0% vs 13.2%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.78) with nausea and vomiting as main side effects. AIH remission rates were comparable among groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The discontinuation rate of AZA in AIH treatment is ~15% in the first year of treatment. Early or delayed AZA initiation does not differ in remission and discontinuation rates in AIH induction therapy. Our data suggest that either strategy may be used as part of AIH treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.14513","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:12:16Z","timestamp":1589501536000},"page":"2164-2171","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3770-4568","authenticated-orcid":false,"given":"Simon","family":"Pape","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboud University Medical Center Nijmegen The Netherlands"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom J. G.","family":"Gevers","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Radboud University Medical Center Nijmegen The Netherlands"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Maarten","family":"Vrolijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Rijnstate Hospital Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"van Hoek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Bouma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology VU University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carin M. J.","family":"van Nieuwkerk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology VU University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9270-2496","authenticated-orcid":false,"given":"Richard","family":"Taubert","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Jaeckel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Manns","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Papp","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Faculty of Medicine University of Debrecen Debrecen Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Sipeki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Faculty of Medicine University of Debrecen Debrecen Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Stickel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital of Zurich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6593-5702","authenticated-orcid":false,"given":"Cumali","family":"Efe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Harran University Hospital Urfa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersan","family":"Ozaslan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Numune Research and Education Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tugrul","family":"Purnak","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hacettepe University Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Nevens","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital KU Leuven Leuven Belgium"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik J. N.","family":"Kessener","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Clinic of Essen Duisburg Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisan","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Clinic of Essen Duisburg Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-0480","authenticated-orcid":false,"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Clinic of Essen Duisburg Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Hartl","sequence":"additional","affiliation":[{"name":"1st Department of Internal Medicine University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schramm","sequence":"additional","affiliation":[{"name":"1st Department of Internal Medicine University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"Martin Zeitz Centre for Rare Diseases University Medical Centre Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-3129","authenticated-orcid":false,"given":"Ansgar W.","family":"Lohse","sequence":"additional","affiliation":[{"name":"1st Department of Internal Medicine University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Heneghan","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies King's College Hospital London UK"},{"name":"European Reference Network RARE\u2010LIVER Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8027-3073","authenticated-orcid":false,"given":"Joost P. 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