New monitoring tool could be a positive change on the horizon for children with autoimmune hepatitis
- October 6, 2020
- AIH, LiverMultiScan
- Chloe Hutton, Elizabeth Shumbayawonda, Jasmin Hounsell
Oxford October 6th, 2020. State-of-the-art non-invasive multiparametric MRI could offer new possibilities for monitoring and treatment of autoimmune hepatitis (AIH) in children, potentially reducing unnecessary biopsies, shows the latest study by Perspectum.
Autoimmune hepatitis (AIH) affects patients throughout their entire lives. This chronic disease occurs when the body’s immune system attacks the liver cells causing inflammation and scarring (fibrosis). Without appropriate care, AIH can lead to advanced liver disease, liver failure requiring a liver transplant, and even death.
The causes of AIH are not clear, but the disease is more common in women. Typical symptoms include fatigue, nausea, jaundice, as well as pain in the joints, muscles, and tummy. Patients often experience recurring periods when symptoms are reduced or absent, followed by disease flares, when they suddenly get worse, making it especially difficult to manage. Although rare, (affecting between 10 and 17 people per 100,000 in Europe, British Liver Trust), patients with AIH require on-going treatment to reduce the immune system’s attack and regular blood tests to monitor the disease. Patients (especially paediatrics) may need to have a liver biopsy (for disease monitoring), which has many limitations, not least the pain, but also risk of bleeding and even death. Sometimes the patient’s liver biopsy shows active disease even though the blood tests are normal; up to 80% of those patients may experience a disease flare. This stresses the unmet need for non-invasive tools to monitor disease in AIH patients, and especially to reduce invasive procedures in children.
In this study, Perspectum’s non-invasive MRI technology, LiverMultiScan®, was used to evaluate liver health in 60 children with AIH at the Children’s Memorial Health Institute in Warsaw. LiverMultiScan’s cT1® provided a detailed evaluation of liver fibrosis and inflammation which agreed with biopsy scores and blood markers of disease activity and severity. Patients were assessed at visit 1 and after an average follow-up of 16-months. Most showed significant reductions in disease resulting from treatment (biopsy confirmed), which could be monitored using cT1. Importantly in six patients, biopsy and cT1 results clearly indicated active disease despite blood tests being normal.
These results demonstrate how cT1 could offer an alternative to biopsy for monitoring disease, potentially having an important impact on clinical practice and treatment guidelines, which frequently diverge because of the reluctance to perform liver biopsies. This new non-invasive tool could be used to improve care and quality of life for AIH patients by optimising treatment pathways and reducing unnecessary biopsies.
Dr Elizabeth Shumbayawonda, co-author on the study and Senior Scientist at Perspectum commented, “Paediatric AIH is notoriously difficult to treat as it is generally more aggressive than in adults. Non-invasive techniques have the potential to play a critical role as they provide quick and accurate pain-free alternatives for patient disease management. This study demonstrates how MRI scanning can be used to identify two important groups of children; the first group being those with active disease who require a change in their treatment to better manage their AIH, and the second being those in disease remission who will not benefit from having monitoring biopsies.“