Peer-reviewed article
Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay.
Or Steg Saban, Shannon M Vandriel, Syeda Aiman Fatima, Celine Bourdon, Amrita Mundh et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how children with autoimmune hepatitis respond to standard corticosteroid treatment. The research found that children receiving prednisone therapy experienced significant weight gain and slowed height growth that did not recover over time. Higher doses of prednisone and diagnosis at younger ages were associated with worse growth outcomes. The findings suggest that current treatment approaches may need adjustment to better protect children's physical development.
Key points
- Children with autoimmune hepatitis on prednisone showed sharp increases in body mass index z-score and significant declines in height-for-age z-score
- Each additional 1 mg/kg/day of prednisone increased weight gain by 0.27 z-score units in the first 6 months and decreased height by 0.02 z-score units
- 72% of children diagnosed before puberty developed excessive weight gain compared to 49% diagnosed during puberty
- 63% of children diagnosed before puberty developed obesity compared to 32% diagnosed during puberty
- Young age at diagnosis and prednisone doses exceeding 10 mg daily at 6 months were predictors of linear growth delay
Limitations
The study is observational and limited to children treated at one hospital in Canada, so findings may not apply to other populations or treatment settings. The analysis cannot determine whether modified steroid protocols or alternative treatments would produce better outcomes.
Abstract
BACKGROUND: Standard-of-care therapy in children with autoimmune hepatitis (AIH) includes induction with prednisone 1-2 mg/kg daily with gradual weaning of the dose. We aimed to test the hypothesis that children with AIH receiving standard-of-care treatment have altered growth trajectories. METHODS: Children diagnosed with AIH between 1997 and 2023 at SickKids had serial growth measurements. Mixed effect models assessed the impact of time and daily steroid exposure on z-scores. Kaplan-Meier survival methods were used to estimate the cumulative incidence of new-onset growth impairments. A time-dependent Cox proportional hazards model was constructed to determine predictors for growth impairments. RESULTS: Sixty-one children (66% females, median age at diagnosis 11.5 y) were included. BMIz showed a sharp increase, and HAZ declined significantly without returning to baseline. Each 1 mg/kg/d prednisone exposure increased BMIz gain in the first 6 months by 0.27 ([95% CI: 0.11, 0.42], p = 0.001), and decreased HAZ by -0.02 ([95% CI: -0.03, -0.01], p = 0.005). Children diagnosed before puberty exhibited a higher occurrence of excessive weight gain (72.2% vs. 49.3%; log-rank p < 0.01) and obesity (63% vs. 31.5%; log-rank p < 0.01) compared to those diagnosed during puberty. In a Cox proportional-hazards model, young age at diagnosis and daily prednisone dose >10 mg 6 months after diagnosis were predictors for linear growth delay. CONCLUSIONS: This study demonstrates that children with AIH receiving standard-of-care therapy demonstrate altered growth trajectories, long-term excess weight gain, obesity, and linear growth delay. Young age at diagnosis and >10 mg of daily prednisone at 6 months are predictors for linear growth delay. These data indicate the need to re-evaluate standard treatment algorithms for pediatric AIH in terms of steroid dosing and potential nonsteroid alternatives.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Standard-of-care therapy for autoimmune hepatitis consisting of prednisone induction at 1-2 mg/kg daily with gradual dose weaning
- Population
- 61 children (66% female, median age at diagnosis 11.5 years) diagnosed with autoimmune hepatitis between 1997-2023
Key finding
BMI z-score increased sharply and height-for-age z-score declined significantly without returning to baseline