LiverMultiScan shown to be the best non-invasive predictor of disease activity in autoimmune hepatitis, demonstrating its potential to influence clinical treatment.
Oxford March 3rd 2021. LiverMultiScan®’s cT1® is the best predictor of autoimmune hepatitis (AIH) disease activity, as shown in a recent publication, which demonstrates its potential to influence clinical treatment and so reduce likelihood of disease progression.
AIH is a chronic liver disease characterised by liver inflammation, which affects patients throughout their entire lives. Patients often experience recurring periods when symptoms are reduced or absent, followed by disease flares, when they suddenly get worse, which makes the disease especially difficult to manage. Without appropriate care, AIH can lead to advanced liver disease, liver failure requiring a liver transplant, and even death.
Immunosuppressants are used to reduce liver inflammation and maintain long-term disease remission in AIH, but objective assessment of disease progression is a challenge. Although liver biopsy is typically used to diagnose AIH, clinicians are reluctant to use it for disease monitoring due to its many limitations, which include not only pain, but also risk of complications from the procedure itself, as well as errors in the measurement. Clinical practice standardly uses blood tests to check the levels of liver enzymes which indicate disease status, but normal liver enzymes do not always necessarily indicate the absence of active disease. The clinical imperative to offer tailored therapeutic intervention with the lowest immunosuppression burden therefore stresses the unmet need for non-invasive tools to accurately monitor disease in AIH patients.
In the current study, published in Hepatology Communications, 62 AIH patients were scanned at baseline and follow-up with Perspectum’s non-invasive quantitative MRI technology, LiverMultiScan®, which uses a well validated marker of liver fibro-inflammation, cT1® (e.g. see Jayaswal et al, 2020). The results showed that failure to maintain disease remission was associated with significant increases in cT1 but not liver stiffness (using FibroScan® TE) or ELF blood test. Furthermore, baseline cT1, but not liver stiffness or ELF, was a significant predictor of future loss of biochemical remission demonstrating LiverMultiScan’s potential to inform a pre-emptive change in treatment to reduce the likelihood of disease progression.
“Although liver biopsy is the gold standard on which disease resolution and treatment withdrawal decisions are made, there is still a very high relapse rate with up to 50% of patients having to come back on treatment within the first 6 months following withdrawal. The lack of sensitivity of blood tests also means that active sub-clinical disease is not usually detected and thus increases the challenge on patient management,” explained Dr Elizabeth Shumbayawonda, Senior Scientist at Perspectum. “cT1 measurements obtained with LiverMultiScan can help to identify those who will have a progression in their disease and thus have a disease relapse despite being in biochemical remission. Early identification of these individuals with high risk disease before they have a disease relapse is of utmost importance as it can positively impact patient monitoring by reliably identifying those who have active sub-clinical disease despite having normal blood markers.”
This proof-of-concept study emphasizes how LiverMultiScan is a disruptive technology with potential to change how patients with AIH are clinically managed and shows promise for the phenotyping and detection of individuals with high-risk disease, who may not be identified using blood tests alone.
Read the full paper here.